What Happens If You Become Hiv Infected While Taking Prep (Truvada?)

[Chubtop]

Hello,

 

I am currently taking PrEP (Truvada) and have been taking the drug since August of 2014 to prevent posible HIV infection.  I have a question I keep forgetting to ask my doctor who prescribes and tests me for HIV on a regular basis and was hoping I could ask here, that someone might know.

 

If you become HIV positive while on PrEP (I realize it's rare and so far only one person has become positive while on PrEP earlier this year)...if one becomes positive in between HIV testing periods, is continuing to take the drug during the time in between tests going to cause any harm?  In my case I am tested every 6 months.  Obviously we're not getting tested daily so you don't really know if you become positive until you next routine checkup/appointment with your doctor.  The ID center that I go to only requires us to come in every 6 months, instead of the recommended 3 months that is commonly seen in articles online or from the CDC.

 

Thank you

Edited May 19, 2016 by Chubtop

[rawfuckr]

You should stop Truvada ASAP if you become HIV+ to avoid drug resistance, which happens almost always on the PrEP breaktrhough cases.

 

Therefore, 6 month checkups are way too long. You should do them every 3 months, with a 4th generation test if possible.

[bearbandit]

I'd push for three monthly monitoring as that's what the PrEP protocol recommends, for a start. Change doctors if necessary.

The one seroconversion that's happened was inevitable statistically: it just happened sooner than most people thought it would. Apparently the dual resistant strain of HIV has mutated at one point along its RNA: the site has been mapped and is included in resistance tests that PwHIV have. The spanner in the works is that it needs a VL of 1000 (last I heard: if someone else knows differently, reference please!) to do a resistance test. The good news is that mutated virus is weaker virus so eventually resistant virus returns to wild-type, which is why some drugs can be re-used after a layoff of a few years.

If you were unlucky enough to get the mutated virus (and I'll leave out lottery number comparisons), all that would happen is that for a while you'd be receiving substandard medication. Remember that not all the virus in the load that infected you would be mutated, only an unknown proportion of it, and the unmutated virus would still be susceptible to truvada. However truvada alone isn't an adequate treatment: you need at least one more drug from another class (both drugs in truvada are NRTIs - nucleoside reverse transcriptor inhibitors, reverse transcriptase being an enzyme HIV needs to reproduce). Basically, you'd be in the position of someone with HIV before the discovery of protease inhibitors and the development of combination therapy: some therapy but not enough. However, come your next appointment and the positive test result you'd be on full therapy before you had a chance to sit down.

Dual therapy with truvada isn't by any means the best we can do today, but it's still better than nothing. Because of the state of knowledge and how the epidemic unfolded I went nine years without any therapy, and a further seven with therapies now proven to be inadequate in the extreme. Even with the worst immune response imaginable to HIV and no treatment whatsoever, you'd live more than a couple of years: my partner who, died in 1992, was a virgin until 1983 when he discovered a leatherbar...

 

Basically, just make sure that you keep taking the pills, don't worry and enjoy yourself!

<edit on seeing rawfuckr's post> Obviously the medication offered is unlikely include truvada, but it is possible. As I understand it, last I heard of the guy in Canada is that he's using truvada along with other drugs. In other cases of people seroconverting on PrEP there's either been a degree of non-adherence or else the person concerned was in the very early stages of infection (and therefore the virus not found by testing) when starting PrEP.

[Chubtop]

The ID center I go to is a very well known center in Northern, VA (immediate suburb of DC) and has been mentioned in many medical magazines over the years.  It's hard to imagine they don't know what their talking about with regards to 3 month vs 6 month (they claim the CDC recommends 3 months but 6 months is suitable and up to the doc's discretion.)  They told me that most people will not come in every 3 months and that they feel it's not necessary and that 6 months is just fine.

 

Now I'm even more interested in hearing other people's PrEP check in times, maybe I'll create a thread or a poll asking people how often their Doctors require check-ins/testing.  This is very interesting.

[C10H15N]

... add another drug to my daily Truvada and keep fucking.

[sdbarehunter]

I've been told that if I become positive while on prep (which is unlikely since I take take it every day) they would immediately put me on a full hiv regimen. Prep is basically two medications that is half of the regular cocktail. My hmo will not continue to pay for my truvada unless I get tested every 3 months. for hiv, stds and kidney functions. My prep nurse told me one issue with converting while on prep is that truvada might not be an option for regular treatment of hiv because of possible resistance. Truvada is commonly but not always used to treat hiv. Therefore hypothetically if I converted, the cocktail mixes available might be more limited than had I not taken prep. Nevertheless some other combination could work.

[Mjai4854]

Does prep pop up on drug test that jobs do or military drug test?

[C10H15N]

Does prep pop up on drug test that jobs do or military drug test?

No. Those tests are only looking for non-prescribed "get you high" drugs. Technically, Truvada is my best recreational drug.