Man Acquires HIV While On Prep

[+ Gar1eth]

I've been wondering if/when this would occur.

 

First documented case of man on PrEP testing positive for HIV made public

But researcher in case study insists it's not 'a situation which calls for panic'

http://www.gaystarnews.com/wp-content/uploads/2015/10/truvada_youtube.jpg

YouTube.com

Daily doses of daily doses of Truvadaare taken as pre-exposure prophylaxis (PrEP)

26 February 2016

by Greg Hernandez

 

For the first time, a gay man who had been on a daily regimen of the drug Truvada as pre-exposure prophylaxis (PrEP), has tested HIV positive.

 

The 43-year-old man had been taking the drug regularly for 24 months, had previously responded well to it, and appears to have been infected very recently.

 

Richard Harrigan, PhD, director of the lab program at the British Columbia Center for Excellence in HIV/AIDS in Vancouver, Canada, was one of the researchers on this case study and tells Poz.com: ‘This case demonstrates that while PrEP is beneficial, we can’t rely on it to be an infallible magic bullet.’

 

‘I certainly don’t think that this is a situation which calls for panic,’ Harrigan adds. ‘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.’

 

An estimated 21,000 Americans are currently on Truvada which was approved as PrEP by the US Food and Drug Administration in 2012. Last November, the Centers for Disease Control recommended that one in four sexually active gay and bisexual men take the blue pill.

 

Experts say while they believe such a case will be rare, it happened because the man contracted a virus resistant to tenofovir and emtricitabine which are the two drugs in Truvada.

 

While CDC guidelines recommend that men who have sex with men take Truvada every day for protection, researchers have estimated that men take it at least four times a week are more than 99 % protected against HIV.

 

The HIV positive man is being successfully treated and his viral load is currently fully suppressed.

 

 

‘This person claims he was taking PrEP every day and I believe him,’ Dr. Robert M. Grant tells Poz.com.

 

Grant is a professor at the University of California, San Francisco, who headed the 2010 drug trial that first proved PrEP’s effectiveness.

 

‘After 32 years of experience with HIV research, I have learned never to say “never,”‘ he adds. ‘Yet I also think that gay men benefit from feeling safer during sex, and I am grateful that PrEP affords that feeling.’

 

 

HAVE YOUR SAY

 

© Gay Star News.

[sincitymix]

I've been wondering if/when this would occur.

 

First documented case of man on PrEP testing positive for HIV made public

But researcher in case study insists it's not 'a situation which calls for panic'

http://www.gaystarnews.com/wp-content/uploads/2015/10/truvada_youtube.jpg

YouTube.com

Daily doses of daily doses of Truvadaare taken as pre-exposure prophylaxis (PrEP)

26 February 2016

by Greg Hernandez

 

For the first time, a gay man who had been on a daily regimen of the drug Truvada as pre-exposure prophylaxis (PrEP), has tested HIV positive.

 

The 43-year-old man had been taking the drug regularly for 24 months, had previously responded well to it, and appears to have been infected very recently.

 

Richard Harrigan, PhD, director of the lab program at the British Columbia Center for Excellence in HIV/AIDS in Vancouver, Canada, was one of the researchers on this case study and tells Poz.com: ‘This case demonstrates that while PrEP is beneficial, we can’t rely on it to be an infallible magic bullet.’

 

‘I certainly don’t think that this is a situation which calls for panic,’ Harrigan adds. ‘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.’

 

An estimated 21,000 Americans are currently on Truvada which was approved as PrEP by the US Food and Drug Administration in 2012. Last November, the Centers for Disease Control recommended that one in four sexually active gay and bisexual men take the blue pill.

 

Experts say while they believe such a case will be rare, it happened because the man contracted a virus resistant to tenofovir and emtricitabine which are the two drugs in Truvada.

 

While CDC guidelines recommend that men who have sex with men take Truvada every day for protection, researchers have estimated that men take it at least four times a week are more than 99 % protected against HIV.

 

The HIV positive man is being successfully treated and his viral load is currently fully suppressed.

 

 

‘This person claims he was taking PrEP every day and I believe him,’ Dr. Robert M. Grant tells Poz.com.

 

Grant is a professor at the University of California, San Francisco, who headed the 2010 drug trial that first proved PrEP’s effectiveness.

 

‘After 32 years of experience with HIV research, I have learned never to say “never,”‘ he adds. ‘Yet I also think that gay men benefit from feeling safer during sex, and I am grateful that PrEP affords that feeling.’

 

 

HAVE YOUR SAY

 

© Gay Star News.

 

Well as I did say in another thread, was only a matter of time before someone ran into a Truvada resistant virus strain but one case out of how many is still pretty decent odds.

[Becket]

Saw this here.

 

http://www.dailymail.co.uk/health/article-3464517/Gay-man-taking-daily-HIV-prevention-pills-contracts-resistant-strain-virus-recorded-case-PrEP-failing.html

[+ Gar1eth]

Well as I did say in another thread, was only a matter of time before someone ran into a Truvada resistant virus strain but one case out of how many is still pretty decent odds.

 

There always has to be a first one. And Truvada used for PrEP has only been approved for 3-1/2 years so far. The question will it be-is it just this one guy? Or is it the beginning of an epidemic.

 

Gman

[sincitymix]

There always has to be a first one. And Truvada used for PrEP has only been approved for 3-1/2 years so far. The question will it be-is it just this one guy? Or is it the beginning of an epidemic.

 

Gman

we really wont know the answer to that, as I do not believe anyone keeps records or statistics of patients who have to change meds due to acquiring a resistance to an HIV medication, from those who have taken it for XXX amount of years with no interruption of therapy and has to change due to the virus mutating and becoming resistant.. to those who are non compliant with therapy and allows the virus to mutate due to letting the active ingredient in the body to drop off.

Hmm im sure at least many of the PBMs and pharmacies at least have records of patients who have been on medication XYZ and changed to ABC. That would be helpful on at least narrowing down the possible number of resistant patients. I know they do share data for research purposes.

[Mikegaite]

AHF will be all over this case. Let's hope it's an isolated incident.

[Brian Kevin]

This was my biggest real and why i remained to stick to condoms.

[LADoug1]

PrEP was never presented as 100% effective in protecting against HIV. The percentage was always in the high 90's. So there was always a small window of non-effectiveness. I'm not surprised about this story. Sad but true.

[+ quoththeraven]

There always has to be a first one. And Truvada used for PrEP has only been approved for 3-1/2 years so far. The question will it be-is it just this one guy? Or is it the beginning of an epidemic.

 

Gman

 

There's a third possibility: that won't be isolated to him but it won't be an epidemic either.

[ChrisWydeman]

This was my biggest real and why i remained to stick to condoms.

There are over 50,000 people on prep and after 3 and a half years this is the first documented case of this happening. This seems like it might have better odds than a condom

[marylander1940]

I thought the PrEP advertisement said: "if used with condoms..."

[+ Gar1eth]

There are over 50,000 people on prep and after 3 and a half years this is the first documented case of this happening. This seems like it might have better odds than a condom

 

While I don't know for sure, I would imagine condom failure really only occurs if there is a break in the condom. I really have trouble seeing that if condoms are effective with as high a rate as they are the virus passing through latex. So condom failures in most cases are visible. This guy however was taking his Truvada. This failure is invisible. That doesn't bode well.

 

I hope as a community we aren't as blind to the implications of this (but I'm afraid we will be) as in the early days of the HIV epidemic when people refused to start wearing condoms or protested against the closing of the bath houses.

 

The question now is how many times is a failure like this going to occur-because it is going to occur again repeatedly. How many failures are going to have to occur before we should worry-5, 10, 15, 300? You can't tell me @ChrisWydeman that people haven't been using Truvada over the last 3-1/2 years as a get-out-of-jail free card as if there were no worries anymore. But people want to go bare. Until our noses are rubbed in it by repeated Truvada failures, I fear the average guy is not going to pay any attention to this.

 

Gman

[Tigger]

I thought the PrEP advertisement said: "if used with condoms..."

 

That was the 'official ' advice to use it as an adjunct to condoms. But the mathematical models predicted high levels of protection without using a condom.

[+ Lance_Navarro]

Please read my recent post about HIV infections due to condom failure. I agree that condoms + PrEP would provide added protection, however to say that condoms alone are an acceptable form of protection, but not PrEP alone, simply ignores statistical evidence.

[mike carey]

Thanks for your thoughtful interventions Lance!

[Nathan_L]

.

[ChrisWydeman]

While I don't know for sure, I would imagine condom failure really only occurs if there is a break in the condom. I really have trouble seeing that if condoms are effective with as high a rate as they are the virus passing through latex. So condom failures in most cases are visible. This guy however was taking his Truvada. This failure is invisible. That doesn't bode well.

 

I hope as a community we aren't as blind to the implications of this (but I'm afraid we will be) as in the early days of the HIV epidemic when people refused to start wearing condoms or protested against the closing of the bath houses.

 

The question now is how many times is a failure like this going to occur-because it is going to occur again repeatedly. How many failures are going to have to occur before we should worry-5, 10, 15, 300? You can't tell me @ChrisWydeman that people haven't been using Truvada over the last 3-1/2 years as a get-out-of-jail free card as if there were no worries anymore. But people want to go bare. Until our noses are rubbed in it by repeated Truvada failures, I fear the average guy is not going to pay any attention to this.

 

Gman

You objections to prep are admirable but ultimately irrelevant. People will do what they want to do regardless of your approval. I work in public health and telling people to do something because "they should" is the most ineffective argument out there. Harm reduction is the most effective and that's what prep is.

 

You can chastise people until the cows come home and it may make you feel better but ultimately it will have little to no effect. We have had this discussion many times and on the forum and while many of people are content just to tell people not to do something the reality is it doesn't work.

 

How well did Nancy Reagans "just say no" policy work? What makes you think saying no to barebacking is going to make it stop?

[marylander1940]

That was the 'official ' advice to use it as an adjunct to condoms. But the mathematical models predicted high levels of protection without using a condom.

 

yes, I know... unfortunately people use one thing or the other.

[caliguy]

While I don't know for sure, I would imagine condom failure really only occurs if there is a break in the condom. I really have trouble seeing that if condoms are effective with as high a rate as they are the virus passing through latex. So condom failures in most cases are visible. This guy however was taking his Truvada. This failure is invisible. That doesn't bode well.

 

I hope as a community we aren't as blind to the implications of this (but I'm afraid we will be) as in the early days of the HIV epidemic when people refused to start wearing condoms or protested against the closing of the bath houses.

 

The question now is how many times is a failure like this going to occur-because it is going to occur again repeatedly. How many failures are going to have to occur before we should worry-5, 10, 15, 300? You can't tell me @ChrisWydeman that people haven't been using Truvada over the last 3-1/2 years as a get-out-of-jail free card as if there were no worries anymore. But people want to go bare. Until our noses are rubbed in it by repeated Truvada failures, I fear the average guy is not going to pay any attention to this.

 

Gman

Using truvada alone is still more effective then using condoms alone statistically speaking. You can also add in transmission rates from things like cuts in the mouth or the penis that condoms do little for.

[+ Gar1eth]

Using truvada alone is still more effective then using condoms alone statistically speaking. You can also add in transmission rates from things like cuts in the mouth or the penis that condoms do little for.

 

I think I've mentioned the risk with oral sex before and @ChrisWydeman and others have rightfully pointed out that the risk of acquiring HIV from giving fellatio is very low-although the CDC says it's possible. If you consider how easy it is to get a gum injury-even brushing causes it-if all mouth injuries greatly increased the risk for HIV, there would be a lot more infections out there.

 

The problem is people want to go bare. And as in the early days of the epidemic, they aren't going to listen until this becomes a raging firestorm.

 

Gman

[ChrisWydeman]

I think I've mentioned the risk with oral sex before and @ChrisWydeman and others have rightfully pointed out that the risk of acquiring HIV from giving fellatio is very low-although the CDC says it's possible. If you consider how easy it is to get a gum injury-even brushing causes it-if all mouth injuries greatly increased the risk for HIV, there would be a lot more infections out there.

 

The problem is people want to go bare. And as in the early days of the epidemic, they aren't going to listen until this becomes a raging firestorm.

 

Gman

Let's change the topic but still pertinent, iv drug use. People are still going to use iv drugs even through you tell them it's bad right? they know it's bad, you know it's bad so we can all agree it's bad right? Rather than throw your hands up and just say what your doing is bad why not engage in harm reduction so when they do decide to change their behavior they aren't suck with life long consequences? You provide a needle exchange and reduce the harm they are doing to themselves. In the case of prep give them a pill to dramatically lower transmission rates. We can continue through our hands up and chastise people but ultimately it's a waste of time

[caliguy]

I think I've mentioned the risk with oral sex before and @ChrisWydeman and others have rightfully pointed out that the risk of acquiring HIV from giving fellatio is very low-although the CDC says it's possible. If you consider how easy it is to get a gum injury-even brushing causes it-if all mouth injuries greatly increased the risk for HIV, there would be a lot more infections out there.

 

The problem is people want to go bare. And as in the early days of the epidemic, they aren't going to listen until this becomes a raging firestorm.

 

Gman

Of coarse they want to go bare. It's the natural way of having sex. It's not my personal choice but I do understand it.

 

As far as the raging firestorm I just go by statistics. In SF the hiv rates are dropping for the first time and attributed to PreP use.

 

http://sfist.com/2015/09/03/three-year_study_in_sf_shows_no_new.php

 

http://www.hivplusmag.com/prevention/2015/09/21/san-francisco-sees-drop-hiv-cases-and-death-rates

[seaboy4hire]

I've said it once and I'll say it again, you do what is right for you and allow the other person do what is right for them. Ultimately you are responsible for your own actions. If you feel safer using a rubber, do it. If you feel safer popping a pill, do it. If you feel safer using both, do it. Enough with this shaming! It's stupid and in my eyes make you look as fucking stupid as a rock! If this post gets you all butt hurt too fucking bad!

 

Hugs,

Greg

[seaboy4hire]

And another thing! Would some of you who are only pro rubber go and shame someone who became poz even though he used a rubber rather than not? Quit being fucking hypocrites and grow the fuck up! Fuck! Fuck! Fuck! FUUUUUUUUCCCCCCCCKKKKKKK!!!!!!!!!! Now pardon me while I look for some chocolate and simmah. Some of y'all! I swear to jeebus!

 

Hugs,

Greg

[+ purplekow]

This is not just an individual problem, this is a society problem. Saying "do what you want to do" is irresponsible.

Do not drive drunk. People do it. You do not encourage it.

Do not smoke cigarettes. People do it. You do not encourage it.i

Do not have unprotected sex. People do it. Up until this case, the PREP proponents said, that PREP is enough. They may need to reconsider.

 

PREP may be fine but not ideal for people who can tolerate the drug, afford the drug, and take the drug as prescribed. Adding a condom to PREP or PREP to a condom, likely increases safety. So the recommendation should not be do what you want. The recommendation should be do what is safest. Failing that, which is abstinence, then do the most you can do. Most people will not abstain and so will not do the most they can do. That does not mean that they should not be encouraged to do the most they can do. They should not be encouraged to do whatever you want to do, even though ultimately they will do just that. There is a difference between tacit approval and acceptance of individual choice. People will do as they wish but they should not be encouraged to do less than the best.