And the third case is here

[rawfuckr]

http://www.aidsmap.com/page/3118230/

Quite bizarre 

[Ranger Rick]

56 partners a month and a heavy drug user. Might have been a factor. 

[shyvers]

And the frequency is shortening. It feels that the PReP BB spring is coming to an end. Winter is coming and we may need to get back to wearing our hoodies.

[myDNA4u]

Still considering the very high condom failure rate, PrEP would seem to be way more effective. 

[BiAggieGuy]

Nothing will ever be 100% effective, but I'd rather use PrEP and take that slight risk.

Given his history, including injecting drugs and several other STDs, this may be a case of simply pushing beyond what PrEP can protect against.

[fskn]

On 2/23/2017 at 11:52 AM, shyvers said:

And the frequency is shortening. It feels that the PReP BB spring is coming to an end. Winter is coming and we may need to get back to wearing our hoodies.

PrEP is a concept, not a single medication.

As was (and is) the case with HIV treatment, new drugs are being studied for HIV prevention. Some are particularly promising for prevention because, unlike the emtricitabine and tenofovir in Truvada, they are not already in use for treatment, making resistant virus even less common.

[MuscledHorse]

Sorry, but I work in health care and I don't care what he claims: The fact he used a pile of recreational drugs, including one that involve the word "injected" takes this off my list of credible PrEP failure.

[6811283]

On Thu Feb 23 2017 at 2:52 PM, shyvers said:

And the frequency is shortening. It feels that the PReP BB spring is coming to an end. Winter is coming and we may need to get back to wearing our hoodies.

The frequency is only shortening because the number of PrEP users is growing so rapidly. There are now probably upward of 200,000 people on PrEP. Three seroconversions = 0.0015%. Since the estimated effectiveness was always 99% max, that's way better performance than anyone expected. This isn't "winter," it's the small margin of error that's to be expected of a highly successful intervention that is -- like everything in life -- not 100%.

I choose not to take PrEP, for reasons others here have shared, but I fully support those who do, and I'm tired of the constant gloom and doom about its effectiveness. 

[drscorpio]

Moderator's Note: Guys we have a section for HIV Fetish where everyone can talk about those topics. This is sexual health. If you want to address people's medical concerns here, that's fine. If you want to praise AIDS and worship HIV, it's not. Take that to the backroom. We don't put up with people talking about how wrong chasing/gifting is in the backroom. We aren't going to put up with you talking about how wrong guys who take PrEP are here. 

[rawfuckr]

On 3/1/2017 at 0:51 PM, MuscledHorse said:

Sorry, but I work in health care and I don't care what he claims: The fact he used a pile of recreational drugs, including one that involve the word "injected" takes this off my list of credible PrEP failure.

I'm sort of in the same place that you are. Guy had 60 partners/month and was hitting every single drug out there.. BUT the researchers have a pretty good case for strong adherence. He had a daily log, his measured levels were totally consistent with daily dosing, and so were his pill counts.  

Still the way he turned + is very strange. Got + AB test with negative/UD PCR test, even with very fine lab HIV testing. If he was taking truvada consistently, and from his dry blood spot samples seems he was, how was he able to seroconvert without a significant viral load? No one knows and its a mistery.

Edited March 5, 2017 by rawfuckr

[DylanM1999]

Keep in PrEP was supposed to be used with a condom as well. Not just taking prep and going BB

[6811283]

14 minutes ago, rawfuckr said:

Still the way he turned + is very strange. Got + AB test with negative/UD PCR test, even with very fine lab HIV testing. If he was taking truvada consistently, and from his dry blood spot samples seems he was, how was he able to seroconvert without a significant viral load? No one knows and its a mistery.

It's pretty fascinating -- this thing about a localized infection in his gut, never heard of such a thing. This case could potentially reveal a good bit about how HIV works. There are mysteries and outliers in every area of medicine... for example, spontaneous remission of Stage 4 cancer.

We'll never understand everything, but we know enough about PrEP at this point to be confident that it is at least as effective as most vaccines or other preventive interventions. It's still a resounding success, even though the naysayers are going to grab every negative story to try to discredit it (something they never do with the tens of thousands of infections due to condom failure).

[6811283]

20 minutes ago, DylanM1999 said:

Keep in PrEP was supposed to be used with a condom as well. Not just taking prep and going BB

And condoms are "supposed to" be used with oral sex -- it's in the CDC safer sex guidelines. These messages are always crafted to be as risk-averse as possible (often for legal liability reasons). It's just like the warnings on the package that you could die from taking Tylenol. The manufacturer of Truvada had to agree to include the condom warning in order to get FDA approval (largely because public health authorities want to keep scaring people into using condoms, to prevent other STDs).

The study results are clear: PrEP prevents HIV infection in well over 99% of cases, whether or not you use a condom. The subjects recruited for the trials were all chosen because they were at very high risk -- most were already not using condoms. They didn't suddenly start using them once they got on PrEP -- but they stopped seroconverting. 

You can choose to use condoms if you want, to reduce the risk of other STDs. But to say that everyone needs to wear them because 3 people got HIV out of approximately 200,000 PrEP users is absurdly overcautious.

Edited March 5, 2017 by 6811283

[Bluepanther89]

From what i have read and researched Prep Truvada only protects you up to 70% if you are im not sure intravenous or recreational drug user; so if he was indeed doing every drug out there it all makes sense now; his protection levels were reduced 29%!

[6811283]

2 hours ago, Bluepanther89 said:

From what i have read and researched Prep Truvada only protects you up to 70% if you are im not sure intravenous or recreational drug user; so if he was indeed doing every drug out there it all makes sense now; his protection levels were reduced 29%!

Recreational drugs can only transmit if used intravenously -- not from snorting, smoking, etc. The patient reported injecting ketamine twice, with clean needles. The researchers seem to believe him (he appears to have been scrupulously honest otherwise), and the assumption is that the transmission was indeed sexual. An intravenous infection wouldn't have resulted in the localized HIV infection in the gut that is the hypothesis. There are still many mysteries about this case, but I'm sure the researchers are well aware of the possibility of IV infection, and have ruled it out with good reason.

See: http://www.aidsmap.com/page/3118230/

Edited March 5, 2017 by 6811283