Man Acquires HIV While On Prep

[+ Gar1eth]

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.

 

 

You misunderstand me. I'm not against taking Truvada for PrEP. I'm against people taking Truvada for PrEP and thinking they have a get out of jail free card. While the risk is decreased, this case shows that barebacking on Truvada is still playing Russian Roulette. People need to know about the risk. And let's wonder how many people this index case might have exposed before he was discovered or how many people has the person he caught HIV from had sex with. That person was obviously detectable. If he had sex with anyone else also barebacking under Truvada's 'protection', then there's a good chance there are other men out there with Truvada resistant HIV. That's how epidemics start. We are going to have to hope that this strain isn't that efficient at causing infection. But that's probably not true as there are at least two guys with it-and most likely more. If this strain spreads then there's a good chance in the coming years that Truvada will still be protective but not as much. So you'll have a generation of men used to going bare-then having to start using condoms again. I'm sure that will go well.

 

As for the mechanism of resistance, well basically you are wrong. The principles although not the specifics are the same whether virus or bacteria-HIV or salmonella-antiviral or antibiotic. You are right in saying the risk isn't solely from third world countries. But there is a large risk there. Apparently you haven't read reports of past drug trials where medication had not been taken correctly, hoarded, or even sold. The same things happen in the first world but not quite as frequently.

 

Gman

[+ Eric Hassan]

You misunderstand me. I'm not against taking Truvada for PrEP. I'm against people taking Truvada for PrEP and thinking they have a get out of jail free card. While the risk is decreased, this case shows that barebacking on Truvada is still playing Russian Roulette. People need to know about the risk. And let's wonder how many people this index case might have exposed before he was discovered or how many people has the person he caught HIV from had sex with. That person was obviously detectable. If he had sex with anyone else also barebacking under Truvada's 'protection', then there's a good chance there are other men out there with Truvada resistant HIV. That's how epidemics start. We are going to have to hope that this strain isn't that efficient at causing infection. But that's probably not true as there are at least two guys with it-and most likely more. If this strain spreads then there's a good chance in the coming years that Truvada will still be protective but not as much. So you'll have a generation of men used to going bare-then having to start using condoms again. I'm sure that will go well.

 

As for the mechanism of resistance, well basically you are wrong. The principles although not the specifics are the same whether virus or bacteria-HIV or salmonella-antiviral or antibiotic. You are right in saying the risk isn't solely from third world countries. But there is a large risk there. Apparently you haven't read reports of past drug trials where medication had not been taken correctly, hoarded, or even sold. The same things happen in the first world but not quite as frequently.

 

Gman

 

Thanks for clarifying your opinions. The current science doesn't support that this strain will spread and become a problem and we currently have awareness of and ability to treat Truvada-resistant strains. Am I correct in understanding that you're worried that we'll just have more resistant strains of HIV? How do you feel about TasP and view it's role in managing HIV in the general population?

 

I can understand how you can view barebacking while taking Truvada can seem like Russian roulette. I'll still take the 99% coverage that it affords me. The only way to be 100% safe from a possible HIV infection is to not have sex with other people.

 

As for the difference in mechanism of ACTION, I am actually correct that Truvada works differently than an antibiotic. We could argue the minutia and will likely have different opinions - that's probably not a worthwhile conversation. As for "apparently not reading the research," I'm not clear at what you mean. I acknowledge that the issues you stated have happened in drug trails and in "real world" situations. I think it's unfair to pin that on third world countries when it can happen anywhere, and I think there's a fallacy in a logical conclusion that Truvada is somehow bad because these things could happen. Using that logic, we could, in theory, decide NO medication can be used/prescribed.

 

I guess I really need to ask you to clarify what your concern is. I'll admit that I hear a lot of negative thoughts about Truvada as PrEP and a fear that we will have a new and different HIV epidemic on our hands. Is that your concern?

[+ Gar1eth]

Thanks for clarifying your opinions. The current science doesn't support that this strain will spread and become a problem

I think you are jumping the gun on what we know. And even if some scientists think they know that, they could very well be wrong. The annals of science and medicine are filled with pronouncements about how a certain anti-infective will be the Holy Grail of anti-infectives. And yet these anti-infectives, while possibly still somewhat effective, have proven to be false messiahs in the sense that no resistance will ever develop to them. Look up the history of Vancomycin-the former antibiotic of last resort, and the fact that while it took a long time to develop there are resistant strains of gram positive organisms to it. And they can be incredibly difficult, sometimes impossible to eradicate.

 

 

Am I correct in understanding that you're worried that we'll just have more resistant strains of HIV? How do you feel about TasP and view it's role in managing HIV in the general population?

 

Having unprotected sex with someone who is HIV positive is always going to be risky. It's one thing in a committed relationship where you can be reasonably sure of their medications and their current viral load. And even then viral load refers to blood levels. No one checks semen levels except in research studies. So we really don't know how long it might take the virus to clear from semen once you achieve an undetectable blood level.

 

For those of us relegated to hook-ups it's another factor entirely. In many cases we don't know whether the person is positive or not, the person's treatment history if they are, if they are taking their medications, or what their viral load is.

 

 

As for the difference in mechanism of ACTION, I am actually correct that Truvada works differently than an antibiotic.

Please look up the mechanism of action of the class of antibiotics known as DNA Gyrase inhibitors-one family of them being the quinolones. The way they interfere with bacterial reproduction is similar in a general way to the mechanism of action most of the antivirals use to inhibit HIV.

 

I think it's unfair to pin that on third world countries when it can happen anywhere,

It has nothing to do with fairness. It's a (sad) fact. In the same way that you might not need a prescription to buy many antibiotics in Mexico, and there are a large number of resistant E. coli strains there. Yes it can and does happen everywhere. But places where oversight of drugs is very lax, follow-up inconsistent, crowded living conditions, hygiene poor, and unclean water supplies have a tendency to be reservoirs of disease and one of the the 1st places resistance occurs. HIV most likely originated in Africa. And then there was the recent Ebola Outbreak.

 

I guess I really need to ask you to clarify what your concern is. I'll admit that I hear a lot of negative thoughts about Truvada as PrEP and a fear that we will have a new and different HIV epidemic on our hands. Is that your concern?

 

I have no problem with PrEp used as an adjunct to condoms. Come back to me in 5 and again 10 years so we can get a better idea of how many actual infections have broken through the PrEP Shield while barebacking. If there hasn't been an upswell of cases then you'll be right, and I'll be very glad. But if you are wrong, then it will be just like the 1980's and the protests against closing the bath houses or wearing condoms.

 

There's really no point in continuing this thread. I will be overjoyed if you end up being correct. But no one knows for sure right now no matter what the scientists say.

 

Gman

[+ Eric Hassan]

 

There's really no point in continuing this thread.

Gman

 

Strongly agree.

[+ quoththeraven]

Tangentially related: an NPR "All Things Considered" segment on Wilhemina's War, a documentary airing tonight on PBS (Independent Lens, 10 pm) exploring the barriers to HIV/AIDS treatment in the rural South (specifically in South Carolina) and how the perception that it only affects white gay men leads to shame and lack of treatment for African-American women and men who are HIV positive.

 

http://www.npr.org/2016/02/29/468607001/wilheminas-war-explores-barriers-to-aids-treatment-in-u-s-south

 

I plan on taping it.

[stop]

not trying to lob a grenade into a heated discussion but thought this was an interesting read.

 

https://www.poz.com/article/meet-man-got-hiv-daily-prep

[+ quoththeraven]

not trying to lob a grenade into a heated discussion but thought this was an interesting read.

 

https://www.poz.com/article/meet-man-got-hiv-daily-prep

 

Thank you for finding and linking a presentation of the facts, some of which coincide with our assumptions (about condom usage) and some of which don't (about compliance with the PrEP regimen and the source of resistance). It's better to know the facts than to speculate.

[stop]

Thank you for finding and linking a presentation of the facts, some of which coincide with our assumptions (about condom usage) and some of which don't (about compliance with the PrEP regimen and the source of resistance). It's better to know the facts than to speculate.

 

I found it very interesting that he doesn't blame prep but blames the guy he hooked up (and himself). The other thing I found especially interesting was the date he found out, back in early 2015. I was under the impression that this was a recent event (past couple of weeks/months) It is quite possible the date was published and I just over looked it.

[+ Gar1eth]

I found it very interesting that he doesn't blame prep but blames the guy he hooked up (and himself). The other thing I found especially interesting was the date he found out, back in early 2015. I was under the impression that this was a recent event (past couple of weeks/months) It is quite possible the date was published and I just over looked it.

 

 

It was recently published all over the place because Joe's case was just presented at a Conference. To have all the data that they had on him-it would have had to have occurred at least a few months back.

 

Gman

[ChrisWydeman]

Strongly agree.

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