Meet The Man Who Got Hiv While On Daily Prep

[seaguy]

Interesting interview with the guy who became HIV+ while on PrEP https://www.poz.com/article/meet-man-got-hiv-daily-prep

[Negasswhore]

Thank´s seaguy, interesting reading. One should always calculate that there is a risk.

[bootmandc]

Great article.  Thanks for posting it.   What I don't understand is they say he contracted "drug resistant" strain, yet he went on meds and they were effective.  Going to read more, but that seems contraditroy.

Edited March 4, 2016 by bootmandc

[tallslenderguy]

Great article.  Thanks for posting it.   What I don't understand is they say he contracted "drug resistant" strain, yet he went on meds and they were effective.  Going to read more, but that seems contraditroy.

Hi bootmandc,

HIV is a rapidly mutating virus that, consequently, exists in different forms. The way science has gotten ahead of HIV is by attacking different aspects of the virus' reproduction. "TRUVADA is a type of medicine called a nucleoside analog reverse transcriptase inhibitor (NRTI)," it attacks the virus at two different levels/places and is generally effective at prevention because it hits HIV before it has a chance to integrate into a persons system and become established (i.e., infect them). All virus' need a host to reproduce, they cannot replicate on their own.  But Truvada does not contain an integrase inhibitor, for instance, a med that attacks a different aspect of HIV infection. I don't know what specific HIV strain this guy has, but apparently it was resistant to the two particular meds as they are formulated in Truvada. The meds they gave him to get the virus under control may have had a different strength, combination or an added component like an integrase inhibitor. 

[dadecounty]

Did I miss something? It seemed to me that "joe" was on PrEP but not Truvada, since Canada didn't approve Truvada until after his conversion. So, what was he on to begin with? And if it wasn't Truvada, there still hasn't been one diagnosed case of conversion of someone who follows Truvada daily.

 

Did I miss something?

[fillmyholeftl]

Did I miss something? It seemed to me that "joe" was on PrEP but not Truvada, since Canada didn't approve Truvada until after his conversion. So, what was he on to begin with? And if it wasn't Truvada, there still hasn't been one diagnosed case of conversion of someone who follows Truvada daily.

 

Did I miss something?

Yes.. You missed something. He was on Truvada as PrEP

[bootmandc]

Thanks tallslender.

 

This article explains it in greater detail.  Don't get it all, but adds to texture - https://www.poz.com/article/prep-fails-gay-man-adhering-daily-truvada-contracts-drugresistant-hiv

[rawfuckr]

According to him the person who gave it to him is someone who is NOT on meds because he doesn't even know himself he's HIV+

 

It sounds a bit strange because from the post-mortem writeups I've seen the most likely route of the multidrug resistant virus would be someone who was failing Stribild treatment, given the very specific profile of this guy's virus resistance. So if that holds:

a) either infecting guy is lying and he knows he's poz, got some meds and taking them poorly or

b )maybe it was someone else, guy says "it was a busy period" 

Edited March 4, 2016 by rawfuckr

[LKMike]

So if the guy who infected him had known he had a strain that was Truvada resistant and was on another medication, he would have been undetectable, and so low risk, but the PrEP would not have protected Joe anyway. Also i am a little confused that in the interview Joe talks about the guy he thinks infected him not knowing and not testing, but in the second article there is a line that seems to say the infector was on medication but not adhering.

Evidence suggests that this single person was failing the HIV single-tablet combination regimen.

Once again i am more convinced to look for HIV+ guys on meds to have sex with.

[dadecounty]

Okay, but here's what I don't get:

If the hiv+ top has a Truvada-resistent strain, and most likely he's fucking other dudes who are on Truvada, then how come there is only one instance of PrEP failing?

 

It just doesn't add up.

 

This top should be pozzing a bunch of dudes on PrEP. We should be seeing a pocket of PrEP men becoming infected, right?

[fillmyholeftl]

From what I understand.. All the genetic and resistance testing/marking were done on the infectees (the guy who got infected) samples.  I don't recall them even identifying the source.  But take this scenario... the guy infected doesn't know hes infected with HIV, let alone a virulent resistant strain.  He's got a HVL, but isn't a PIG... and hasn't bred all that many people... That's why more cases haven't been identified

[bearbandit]

I've been aware of "Joe" since he seroconverted: his story hasn't changed in any respect since he seroconverted. He was indeed on truvada as Canadian law allows for "off-label" prescription - drugs used for another purpose than their stated purpose. And that's all I'm going to say about him: I can't even remember his real name now.

As to why more haven't got HIV from the other guy, as fillmyholeftl said, maybe he just doesn't get around that much. Plus, of course, there's the fact that HIV is pretty hard to catch - it averages out at a 1.4% chance per fuck. And just because you're not on treatment doesn't mean that you've automatically got a high VL: I've got multiple resistances and in 2007 took a drug holiday after  my partner died. After seven months my VL was only 65k. I say "only" because others have gone way higher than that, and others have stayed in four figures. For reference sake 1k is reckoned to be the lowest infectious point; the fuss about being undetectable is (a) belt'n'braces protection for the HIV- guy and ( health protection for the poz guy as HIV causes damage to the body even at extremely low levels. It's simply a question of trying to minimise the damage.

[LKMike]

So did the guy who infected him know he was HIV+, and if so was he on treatment?  Its hard to be clear from the 2 articles., One saying Joe was trying to get the guy he thought pozd him to go get tested, and the second saying the guy was on meds but not aware he was resistant to his meds.

[bearbandit]

<breaking my own damn rules> To the best of my knowledge (gathered from several sources: you'll have to trust me for their accuracy as I will not go any further into breaking confidentiality) the other guy doesn't know or isn't saying he's poz. 
 

Leaving all personalities out of this, we've known all along that something like this would happen sooner or later: nothing in medicine is 100% except for eventual death. Everybody's slightly different from each other, so much so that we can't even agree on what a "normal" blood pressure is, but express it as a range instead. My partner had such low blood pressure naturally that he had to warn medics before they took his blood pressure that they'd find it abnormally low, but that was normal for him and no, he didn't need to be admitted: he was at the far end of the bell-curve for that particular test.

Even a negative HIV test only means that no indication of HIV infection was found on this occasion. I've had viral load tests come back as zero, meaning that no viral particles were observed in my blood. I was right at one end of the bell curve the twice that happened to me.

Sooner or later it was inevitable that someone taking PrEP would be infected with a mutation of HIV that's resistant to tenofovir and emtricitabine, which is why the search is on for the next drug, and the next and so on, just as the search is on for new treatments for HIV disease. The surprise has come in that it's happened relatively quickly: it's only human when something has only a very small chance of happening to expect it to take a long time to happen. A mistaken thought process because given the same circumstances the odds of event *A* happening under circumstances *B* are exactly the same each time event *A* happens under circumstances *B*. Look at guys wanting to get pozzed: some try for years, even decades, whereas others have barely taken the decision before they're popping their first atripla.

 

I was nearly killed by tenofovir, but I recognise that there were a number of circumstances contributing to my situation taking the odds of the combination to well over 1 in 1,000,000: I have no difficulty in urging HIV- men to take PrEP and for poz men to use truvada because what happened to me was such an extremely rare set of circumstances, that the risk of it happening to someone else is outweighed millions to one by the benefits of taking the drug. To sit and dwell on the possibility of it happening to someone else would be like refusing to leave the house for fear of traffic accidents (which are way commoner).