Man Acquires HIV While On Prep

[ChrisWydeman]

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.

And what should do to people who aren't "responsible?"

[+ purplekow]

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

Yeah shaming is bad.

[+ purplekow]

And what should do to people who aren't "responsible?"

Inform them. Suggest better methods and hope for the best. You work in the medical field, you know that is all you can do. Suggest the best. Failing that, suggest the better. Ultimately, the individual does decide, but insofar as one can, you ask for good choices.

I suggest you look both ways before crossing the street. If you choose not to do so, I can not force it. But possibly, you will pay dearly and I will also share, to a much lesser extent, in that expense. .

[+ Lance_Navarro]

I'm just gonna throw a little math out there.

 

50,000 guys on PrEP

x. 20 sex partners (I hope it's ALOT more)

__________________________________

 

1,000,000 individual sex acts without a PrEP seroconversion

 

AND NOW WE HAVE 1!!!!

 

1 in 1,000,000 is pretty impressive protection if you ask me!

 

In all seriousness, do what's comfortable for you, but also be knowledgeable and open minded about how things are evolving. Always seek to learn and grow. A big part of finding happiness is deciding that you don't need to change others to be happy yourself.

 

Love & Light to you all!

[+ Lance_Navarro]

Inform them. Suggest better methods and hope for the best. You work in the medical field, you know that is all you can do. Suggest the best. Failing that, suggest the better. Ultimately, the individual does decide, but insofar as one can, you ask for good choices.

I suggest you look both ways before crossing the street. If you choose not to do so, I can not force it. But possibly, you will pay dearly and I will also share, to a much lesser extent, in that expense. .

 

Where the disagreement lies here, is in that @ChrisWydeman believes in the harm reduction model, and you are more comfortable with the current model that exists in most of the USA. I believe that all drugs need to be decriminalized, the prison population cut 75% and all that money spent on mental and public health. I believe the military needs to be cut beyond that, and put toward education. I believe in needle exchange programs and safe injection sites. I believe in mobile showers and toilets for the homless. I believe we should strive for compassion and understanding and resist judgement and assumption.

[+ Gar1eth]

A big part of finding happiness is deciding that you don't need to change others to be happy yourself.

 

Love & Light to you all!

 

While true on one hand, on the other nothing could be more false. The old truism that 'no man is an island' comes into play here. What others do can affect us as a society both directly and indirectly. I'm no angel at considering society's needs above my own. In this case however, my plan is to keep playing safe. I hope others join me.

 

Gman

[+ nycman]

This really isn't "news".

 

In every study on Prep there was never 100% protection.

[seaboy4hire]

This really isn't "news".

 

In every study on Prep there was never 100% protection.

 

Just like with condoms. Only thing that is 100% is keepin your hole shut and your dick zipped up in your pants.

 

Hugs,

Greg

[+ Gar1eth]

This really isn't "news".

 

In every study on Prep there was never 100% protection.

 

 

From my reading however-and I could be wrong-but while you are correct-the studies did not reveal anyone who became infected who actually had therapeutic blood levels of Truvada and was proven not to have acquired the infection before being on PrEP.

 

The positives that I saw reported in the studies were either from people who said they were taking Truvada but didn't have therapeutic blood levels (i.e. unless their metabolism differs from the average person, they weren't taking the drug daily) or from people unknowingly already HIV positive when started on PrEP.

 

That being said we all know the only 100% things in this world are death and taxes. The question is whether this is an isolated case/ cases or the tip of an iceberg. It doesn't really matter how many people have and are being protected by Truvada now @Lance_Navarro. The determining factors are how common is this resistant strain of HIV and how efficient it is in establishing an infection once someone is exposed to it. We unfortunately will only know this in hindsight.

 

Gman

[+ purplekow]

I'm just gonna throw a little math out there.

 

50,000 guys on PrEP

x. 20 sex partners (I hope it's ALOT more)

__________________________________

 

1,000,000 individual sex acts without a PrEP seroconversion

 

AND NOW WE HAVE 1!!!!

 

1 in 1,000,000 is pretty impressive protection if you ask me!

 

In all seriousness, do what's comfortable for you, but also be knowledgeable and open minded about how things are evolving. Always seek to learn and grow. A big part of finding happiness is deciding that you don't need to change others to be happy yourself.

 

Love & Light to you all!

By that method in 1975 one could have said, 1975 years since the assigned birth of Christ. Number of AIDS cases reported: none. Everything starts somewhere.

There is a difference in doing what is comfortable for you and what it is you suggest to the population as a whole. I feel comfortable driving 85 miles an hour with no seatbelts drinking a beer and getting a blow job. I do not suggest that as a safe thing to do to others.

Again, what any one individual decides is their decision based on free will. But as it is that we all have different thoughts, what we decide to suggest as a community is a different standard.

[LADoug1]

Regarding the use of condoms in conjunction with PrEP, the article didn't say whether or not the man had been using condoms. I think that's important to know.

[+ nycman]

Regarding the use of condoms in conjunction with PrEP, the article didn't say whether or not the man had been using condoms. I think that's important to know.

 

I think the answer is obvious...but you're right...we don't "know".

[ChrisWydeman]

From my reading however-and I could be wrong-but while you are correct-the studies did not reveal anyone who became infected who actually had therapeutic blood levels of Truvada and was proven not to have acquired the infection before being on PrEP.

 

The positives that I saw reported in the studies were either from people who said they were taking Truvada but didn't have therapeutic blood levels (i.e. unless their metabolism differs from the average person, they weren't taking the drug daily) or from people unknowingly already HIV positive when started on PrEP.

 

That being said we all know the only 100% things in this world are death and taxes. The question is whether this is an isolated case/ cases or the tip of an iceberg. It doesn't really matter how many people have and are being protected by Truvada now @Lance_Navarro. The determining factors are how common is this resistant strain of HIV and how efficient it is in establishing an infection once someone is exposed to it. We unfortunately will only know this in hindsight.

 

Gman

There are many strains of resistant HIV the key is to getting that person with a resistant strain on anti retrovirals that work for them so they can get there viral load to undetectable (less than 50 copies per ML of blood). Once they have an undetectable viral load the chances of them passing on their resistant strain is minuscule. There have been resistant strains for many years and this guy just happened to come in contact with particular virulent strain that had a resistance to truvada. To say that this is the tip of the ice burg seems a little silly since truvada has been around since august of 2004, after 11 years there hasn't been a mass resistance to the drug

[+ saminseattle]

How well did Nancy Reagans "just say no" policy work?

 

I've never done drugs. Actually, not even a single puff of a single cigarette. And I owe it all it Nancy Reagan.

 

Seriously though, sometimes telling people what they "should" be doing can affect their behavior. For example, some combination of peer pressure, pricing incentives, and legal requirements has resulted in a very high rate of recycling/composting in my city. Of course, you're never going to get to 100% by trying to guilt trip people, so it's also important to be realistic about the effectiveness of this kind of messaging.

[+ Billsboy4]

My concern with PreP is the long term effects of the drug on one's body. All the studies are short term because the life of the drug hasn't been long enough. There is toxicity with all of these drugs and it's too soon to know what they are. There was an article recently that it's as safe as asperin but the study pointed out that it was in the short term. I worry about the damage it might do to kidneys, liver, pancreas, etc in the long term. I'll stick with condoms.....just my 2 cents.

[MikeyGMin]

My concern with PreP is the long term effects of the drug on one's body. All the studies are short term because the life of the drug hasn't been long enough. There is toxicity with all of these drugs and it's too soon to know what they are. There was an article recently that it's as safe as asperin but the study pointed out that it was in the short term. I worry about the damage it might do to kidneys, liver, pancreas, etc in the long term. I'll stick with condoms.....just my 2 cents.

 

I'm curious to know what you consider short and long term? Truvada has only been used for PrEP for a short time, but it has been used for HIV treatment for many years. I'm too lazy to look it up, but I think it's in the 10-year neighborhood.

 

( Full disclosure: I started PrEP a few months ago so I have obviously made up my mind on the cost-benefit analysis. I wasn't going to wait any longer to get this little extra peace of mind. )

[+ Gar1eth]

There are many strains of resistant HIV the key is to getting that person with a resistant strain on anti retrovirals that work for them so they can get there viral load to undetectable (less than 50 copies per ML of blood). Once they have an undetectable viral load the chances of them passing on their resistant strain is minuscule. There have been resistant strains for many years and this guy just happened to come in contact with particular virulent strain that had a resistance to truvada. To say that this is the tip of the ice burg seems a little silly since truvada has been around since august of 2004, after 11 years there hasn't been a mass resistance to the drug

 

There's a big difference in taking it for treatment and taking it for prophylaxis. People with HIV are going to be a lot more motivated to take it every day. People on prophylaxis may not be quite as motivated as shown by the studies. If the people on prophylaxis only take it some of the time, they'll have lower blood levels. If they get infected with HIV, that's a scenario where resistance can pop up. That's one factor in the development of antibiotic resistance-people not taking the antibiotics consistently.

 

Gman

[ChrisWydeman]

There's a big difference in taking it for treatment and taking it for prophylaxis. People with HIV are going to be a lot more motivated to take it every day. People on prophylaxis may not be quite as motivated as shown by the studies. If the people on prophylaxis only take it some of the time, they'll have lower blood levels. If they get infected with HIV, that's a scenario where resistance can pop up. That's one factor in the development of antibiotic resistance-people not taking the antibiotics consistently.

 

Gman

There is a protocol in place to prevent such a thing from occurring, your required to tested every 3 months when you get a prep prescription

[+ Gar1eth]

There is a protocol in place to prevent such a thing from occurring, your required to tested every 3 months when you get a prep prescription

 

But that doesn't mean people are taking it. Yes they get tested for HIV. They aren't tested for drug levels to see if they are actually taking the drug or taking the drug correctly.

 

In the end-this discussion is pointless, @ChrisWydeman. You've made your opinion known multiple times on this Forum. You are a proponent of Truvada. That's not all bad. But there are risks to it which you seem to ignore. And I'm not talking about the individual kidney or bone side effects. I'm talking about the possible increasing development of HIV resistance from people not taking it consistently plus the fact that the above 90% protection rate is still as of now a mathematical model. The article I read about the guy who became infected on Truvada said that there were only 21,000 people in the USA on prep. That's not really a large enough sample (not to mention most probably haven't been on it over two years) to really know how protective it is.

 

 

Gman

[+ Eric Hassan]

My concern with PreP is the long term effects of the drug on one's body. All the studies are short term because the life of the drug hasn't been long enough. There is toxicity with all of these drugs and it's too soon to know what they are. There was an article recently that it's as safe as asperin but the study pointed out that it was in the short term. I worry about the damage it might do to kidneys, liver, pancreas, etc in the long term. I'll stick with condoms.....just my 2 cents.

 

Truvada has been used for treatment of HIV for 10+ years and there has been a lot of research. It's well tolerated with minimal side effects. Of course, there may be differences in the long term for people using Truvada as PrEP, but I doubt it. When you are using Truvada as PrEP and being properly medically managed, you have bloodwork done every three months including liver and kidney tests. Studies have shown there can be damage to the liver or kidneys AND that this damage is reversed if the medication is stopped.

[+ Eric Hassan]

But that doesn't mean people are taking it. Yes they get tested for HIV. They aren't tested for drug levels to see if they are actually taking the drug or taking the drug correctly.

 

In the end-this discussion is pointless, @ChrisWydeman. You've made your opinion known multiple times on this Forum. You are a proponent of Truvada. That's not all bad. But there are risks to it which you seem to ignore. And I'm not talking about the individual kidney or bone side effects. I'm talking about the possible increasing development of HIV resistance from people not taking it consistently plus the fact that the above 90% protection rate is still as of now a mathematical model. The article I read about the guy who became infected on Truvada said that there were only 21,000 people in the USA on prep. That's not really a large enough sample (not to mention most probably haven't been on it over two years) to really know how protective it is.

 

 

Gman

 

I've read a number of your replies. I understand you have a lot of fear. It might be helpful for you to educate yourself and read the research thoroughly and talk with folks using PrEP. You might want to check out the Facebook PrEP facts group. It is internationally recognized as a resource for folks who are looking for factual information, research, and support. The founder, Damon Jacobs, has spoken at CROI and multiple other HIV/AIDS conferences. Ultimately, you need to make the right choice for you, and that might not be PrEP, but I think it might bring you some peace of mind to know the facts.

[+ Gar1eth]

I've read a number of your replies. I understand you have a lot of fear. It might be helpful for you to educate yourself and read the research thoroughly and talk with folks using PrEP. You might want to check out the Facebook PrEP facts group. It is internationally recognized as a resource for folks who are looking for factual information, research, and support. The founder, Damon Jacobs, has spoken at CROI and multiple other HIV/AIDS conferences. Ultimately, you need to make the right choice for you, and that might not be PrEP, but I think it might bring you some peace of mind to know the facts.

 

 

I've read summaries of the multiple studies. I understand the facts about PrEP. I've also read about the history of anti-infectives in general. For years, pretty much until the 1970's and 1980's, many scientists and doctors thought we were on the way to ending infections as a major cause of illness and death. And then resistant organisms started popping up everywhere. Salmonella used to be treatable by 4 or 5 medications. Now there are probably two major ones left. The history of anti-infectives is full of stories like this.

 

And say that the screening program in the USA does control Truvada use and prevent people from only taking it haphazardly. We have no control over what will happen in 3rd World Countries. Poverty and lack of knowledge will have people taking doses occasionally, selling doses, keeping medications past expiration dates, and other ill informed practices.

 

Gman

[ChrisWydeman]

But that doesn't mean people are taking it. Yes they get tested for HIV. They aren't tested for drug levels to see if they are actually taking the drug or taking the drug correctly.

 

In the end-this discussion is pointless, @ChrisWydeman. You've made your opinion known multiple times on this Forum. You are a proponent of Truvada. That's not all bad. But there are risks to it which you seem to ignore. And I'm not talking about the individual kidney or bone side effects. I'm talking about the possible increasing development of HIV resistance from people not taking it consistently plus the fact that the above 90% protection rate is still as of now a mathematical model. The article I read about the guy who became infected on Truvada said that there were only 21,000 people in the USA on prep. That's not really a large enough sample (not to mention most probably haven't been on it over two years) to really know how protective it is.

 

 

Gman

There are studies about prep and rather than skim through them do yourself and your community a favor and read through them, start to finish. I would assume since your on this forum that your a man that prefers the company of men, it is your obligation as a responsible sexually active adult to be informed on sexual health. Even if your not having sex at the moment it would do you or anyone else concerned with sexual health, a world of good to meet with an HIV specialist or at the very least an LBGT doctor and voice your concerns so you can be better informed.

 

There is a protocol in place to get your perscription renewed you have to get an HIV test. This is done so resistant strains don't form, if someone does show up as positive their strain is genotyped to see what resistances if any are present. Your doctor recommends a cocktail that would be effective and it takes 1-6 months to have a completely surprised viral load. Even if a patient does have a resistance to truvada (and many people do because the medication has been out for over a decade) they aren't very infectious because they are on a cocktail catered to their strain of HIV to effectively keep it in check.

[LADoug1]

My concern with PreP is the long term effects of the drug on one's body. All the studies are short term because the life of the drug hasn't been long enough. There is toxicity with all of these drugs and it's too soon to know what they are. There was an article recently that it's as safe as asperin but the study pointed out that it was in the short term. I worry about the damage it might do to kidneys, liver, pancreas, etc in the long term. I'll stick with condoms.....just my 2 cents.

 

I'm on the same page but I have a very low risk factor due to a small number of exposures. Plus I have a predisposition for Osteoporosis which is known to be a side effect. But for those at high risk (minorities, youth, third world populations) the benefits of using PrEP outweigh the possible unknown side effects.

[+ Eric Hassan]

I've read summaries of the multiple studies. I understand the facts about PrEP. I've also read about the history of anti-infectives in general. For years, pretty much until the 1970's and 1980's, many scientists and doctors thought we were on the way to ending infections as a major cause of illness and death. And then resistant organisms started popping up everywhere. Salmonella used to be treatable by 4 or 5 medications. Now there are probably two major ones left. The history of anti-infectives is full of stories like this.

 

And say that the screening program in the USA does control Truvada use and prevent people from only taking it haphazardly. We have no control over what will happen in 3rd World Countries. Poverty and lack of knowledge will have people taking doses occasionally, selling doses, keeping medications past expiration dates, and other ill informed practices.

 

Gman

 

Well, to split a few hairs here - Truvada is not an antibiotic and HIV is not a bacteria, so I think the comparison to salmonella is inadequate. The mechanism of action of Truvada is completely different from that of an antibiotic and while I'm not certain about whether or not it could cause resistant mutations in an existing infection, it's not a medical surprise that there are "anti-infective" resistant bacteria and viruses. We know there are Truvada-resistant strains of HIV; we've known this for years and we also know we have other medications as options. I don't think this justifies not using or advocating for Truvada as PrEP - to me, that would be akin to advocating not eating food for fear of contracting salmonella and possibly acquiring a strain that is resistant to some antibiotics.

 

You are right that we have no control over what happens in 3rd world countries but I think that statement is fueled by a lot of irrational fear. All of the issues you brought up could happen right here in the USA or any other "first world" country. I think that's why there is a lot of research into how Truvada works and the efficacy of alternative dosing regimens that might work for a broader population. I don't think fear that, for some people, there might be compliance issues is a reason to not advocate for Truvada as PrEP. That kind of logic would lead to not prescribing any medications. Think about that for a minute - if we decided those concerns were good reasons to not prescribe Truvada as PrEP, why would we prescribe any medication at all?

 

It seems to me that a lot of your concerns are shared by a number of people, but the data we have don't support the fear. I think we, as men who have sex with men, carry a collective trauma from the tragedies we have endured from this epidemic. I think that makes Truvada a "tough pill to swallow," but I also think we are living in a time when we have unprecedented access to technology, good research and medications that can cause real change, and enhance the lives of everyone. I can't think of why we wouldn't want to use the tools at our disposal.