Gay Man Taking PrEP Daily Tests Positive For HIV
For the first time, researchers have documented a case in which an individual has contracted a multi-drug resistant strain of HIV.
The man claims that at the time, he was adhering to a daily regiment of Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP).
POZ reports that scientists have come to the conclusion that it’s indeed possible to contract HIV even when adhering to PrEP, when exposed to a strain of the virus that’s resistant to both drugs included in Truvada.
While it’s concerning, experts are suggesting failures like these will be rare.
David Knox, MD is an HIV specialist at the Maple Leaf Medical Clinic and the head author of the case study. The findings were first presented at the 2016 Conference on Retroviruses and Opportunistic Infections (CROI) in Boston.
The 43-year-old man had sex with men while taking PrEP once a day. But after 2 years on Truvada, he tested HIV-positive. Preliminary tests suggest he was acutely infected. The man tested positive for the p24 antigen, which surfaces within roughly three weeks of HIV infection and disappears several weeks later. It was then that he tested negative for HIV antibodies, which typically appear two to eight weeks after infection.
According to POZ:
“Research suggests that men who have sex with men (MSM) who take Truvada at least four times a week are more than 99 percent protected against HIV. (CDC guidelines advise taking Truvada daily for maximum protection, but the drug apparently has a good amount of dosing “forgiveness.”) Real-world use of Truvada as HIV prevention has suggested it is indeed highly effective. For example, none of the more than 1,400 generally high-risk individuals taking PrEP through the Kaiser Permanente San Francisco PrEP program have contracted HIV to date, despite their very high rate of other sexually transmitted infections, including hepatitis C virus (HCV) in two of them.
All of PrEP’s power to curb HIV notwithstanding, this new case study underlines the fact that in science there is, unfortunately, no 100 percent guarantee.”
Robert M. Grant, MD, MPH, a professor at the University of California, says, “After 32 years of experience with HIV research, I have learned never to say ‘never’… yet I also think that gay men benefit from feeling safer during sex, and I am grateful that PrEP affords that feeling.”
Pharmacy records demonstrate the man did indeed fill his Truvada prescription regularly. “This person claims he was taking PrEP every day and I believe him,” said Grant.
Tests suggest the man contracted the virus from a single individual, and while his virus was resistant to multiple drugs, he’s continuing HIV treatment and has a fully suppressed viral load.
Research indicates that resistance to tenofovir, the most commonly prescribed ARV in the world, is increasing. What’s rare is a virus that’s resistant to both tenofovir and emtricitabine, as in this particular case report.
According to Richard Harrigan, PhD, director of the lab program at the British Columbia Center for Excellence in HIV/AIDS in Vancouver, Canada, who was one of the researchers on this case study, “I think we would assume that the efficacy of PrEP would be lower if there is exposure to virus which is resistant to either drug, and lowered further if there is exposure to virus resistant to both drugs.”
“I certainly don’t think that this is a situation which calls for panic. It is an example that demonstrates that PrEP can sometimes be ineffective in the face of drug resistant virus, in the same way that treatment itself can sometimes be ineffective in the face of drug resistant virus.”
“This case demonstrates that while PrEP is beneficial, we can’t rely on it to be an infallible magic bullet.”
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20 Comments
KingBey
February 27, 07:51I never totally believed in this Prep thing. Only true option is to zip up. As long as you’re sexually active and meeting people, you’re at high risk of getting HIV and other brothers and sisters. Prep or no Prep.
DI-NAVY
February 27, 08:37Heard so much about this prep shenanigan. Who am i to preach about abstinence when some people’s libido is so insatiable. The only thing to do is stay protected cos as far as your ass and D is super porous there’s every tendency that you’ll end up getting infected cos at a time, you’ll forget taking the drugs or certainly get tired of swallowing it and you chuk head. oya naaaaa.
bruno
February 27, 08:40the fact that it has taken this long to find the first case of someone who is on prep and has been repeatedly diving in raw getting infected means prep is pretty darn effective and would still be instrumental in making hiv/aids a thing of the past for humanity.
Colossus
February 27, 08:48Try to kill a man and he’ll find ways to survive. Try to kill a virus and same thing happens, No organism wants to die. At least PrEP still has a 99% effective rate, that’s still a huge pass mark.
Max 2.1
February 27, 09:21Touché..
Jamie
February 27, 08:53Okay…so cos of PrEP, you have sex without condoms??? HIV is not the only dangerous STD; and PrEP is supposed to be an accompanying protection with condoms for just in case… Except you have a partner you know you’re sticking to, and you know he’s positive, and you both visit the clinic for your PrEP…or so I guess.
Mr. Big
February 27, 08:53I can’t say I’m very surprised….. But 99% is really high up there. This shows that people need to take more precautionary measures.
Max 2.1
February 27, 09:28But they said Prep is to be used in addiction to a condom Na which together gives you 99.999% protection. But some people just love diving in without condoms. Even the common illnesses we have(Malaria and Typhoid etc) all have resistant strains which normally requires the use of alternative drugs to treat. Why should that of HIV be different?
Just like colossus said, “every organism is trying to survive” and its our job to keep looking for ways to kill the ones that are harmful to us, after all, we’re just trying to survive just like them.
pREp is still pretty much effective in HIV prevention.. Peoole should learn to follow instructions like- putting on a damn condom in combination with using it.
Bobby
February 27, 10:16i fink its a conspiracy…call me paranoid all you want.
those group of rascals that are against making truvada available for the public is behind this. they have paid this man to undermine the faith people have for truvada.
Pink Panther
February 27, 12:02I like the way your mind works, Bobby. Ever worked for Olivia Pope?
Chizzie
February 27, 10:36Well I guess it’s back to sticking with the basics here. Condoms. They still offer the best protection and are affordable and attainable… Although nothing beats the feel of a man’s raw phallus probing deep inside…
So yes, condoms it is…
bruno
February 27, 10:51if you’re looking for 100%, its not condoms either
Mr. Fingers
February 27, 11:23my dear sex is no longer fun with all these risks. Its as if i now ve sex ones in six months due to paranoia. And that ones self the sex might not be great. Mischeeeeeeew.
Khaleesi
February 27, 11:26Heiii!! Just like that my paranoia has hit the roof again!!! Ermm, is there any way one can get PrEP in Nigeria? Seeing as our Government is busy enacting laws against gays rather than embracing policies that safeguard the overall public health of its citizenry in general …
Mr. Fingers
February 27, 11:28The drug is not made for only gay people na.
pete
February 27, 11:2899% effective rate is pretty high. using a condom, sticking to one partner & generally playing safe should be the norm
Bisi Alimi
February 28, 14:18This is an exciting time to be talking about PreP. I personally think the fundamental question is “does PreP work? The answer is not rocket science, yes it does work. Like everyone has said here, the fundamental principle of PreP effectiveness has been never to be used alone. There is absolutely nothing to be scared of based on the result. I am sure this wont be the only guy but I am also sure the impact on PreP promotion will not be damaging.
Many have argued for abstinence and I think it is about human rights here. I want to be able to have access to every support system I can get and thereby make up my mind what is best for me. Is abstinence a tool to preventing HIV? The answer is yes. However one thing abstinence promoters have failed to define adequately is what really does it mean to abstain? Not have penetrative sex? Is wanking, sucking and kissing situated within the discourse of abstinence, or does it mean completely withdrawal from sex and all form of sexual activities?
One thing is clear, human can’t abstain and it is not a mistake, it is the default setting.
So that brings us to what is best; which I personally think is a personal thing. Someone mention other infection. I am within the school of thoughts that think PreP can only prevent you from HIV but not syphilis or Hep C, the two most dangerous STI ever. So what would I prescribe if I am a doctor?
1- Use condom, it is better and more satisfying than Prep
2- If you can’t use condom, then think of having reduce sexual partners and regular sexual health screening
3- If you can use condom, can’t keep your dick or arse in check, I strongly recommend PreP but just be sure it wont prevent other STIs
4- If you are like me (wink) abstain and be a monk. Just make sure children are not involved.
Finally, nothing in life is certain. There is no need to be afraid. The only sure thing in life is death and no matter how careful we are, we are all going to die, so instead of worrying about getting HIV, why not use that energy to live a fabulous and wonderful life.
Amen somebody!!!
okokomaiko
February 28, 17:43thanks Bisi….this exceptional case feeds right into the existing paranoia among gay ppl esp in naija. i was discussing recently w my folks about how high the levels of stigma , fear and paranoia are, even inside the gay community….
how does hiv spread? what are the facts about suppression and transmission? no matter the evidence, it seems some ppl only wanna believe what feeds their fears or fantasies….
Bisi
February 29, 13:19Well it happens every time with every thing under the same. Humans have a way of looking for alternative narrative to things even when they dont exist, but they must force it.
I guess the work is on us to educate one person at a time, a day at a time
Kenny
February 28, 22:09Amen! Word!!!