For the first time, researchers have documented a case in which an individual has contracted a multi-drug resistant strain of HIV.
He 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.
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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.”
H/t: LGBTQ Nation
Jay Fowler
“Gay man using condoms also tests positive to HIV”. Let’s not freak out people.
Realityis
Sad to read this news, but it was bound to happen. And I did call it. Use condoms with PrEP people. If only for the peace of mind …. wow!
Samuel Joiner
I mean it’s not 100% effective. Just like birth control
Realityis
But let’s think about this a bit. If this guy had used a condom along with taking PrEP, he probably would not be HIV + now. I’m not saying condoms don’t fail sometimes, but this is what happens when you don’t follow instructions that are put out there for the benefit of the user.
But hey, let’s keep rolling the dice and hope we don’t meet up with that one person who has a resistant strain. This disease is going nowhere any time soon. So let’s focus on a cure now. Thanks.
Raymond Carlos Thomas II
Oh boy… That’s kind of u fortunate. Then again nothing is fool proof
Paco
There is no safe way to bareback without potentially exposing yourself to disease. Condoms are still necesssary and will be for a long time.
Jean Dickens
Stuart MacKenzie, Fábio Batista,
Paco
I hope the guy he caught the resistant strain from is made aware that he can no longer have sex with guys on PrEP without using a condom too. He will need to tell his partners that the medication alone will not protect them. Otherwise this resistant strain is going to continue to spread.
Eric Steele
PrEP is NIT A SUBSTITUTE FOR CONDOMS! JESUS FAGS GET IT TOGETHER!
Iver Frank Becklund
You could be wearing a condom having sex and get sweat dripped on you and never think you were infected since you were having safe sex
surreal33
Truth hurts and kills. Use home AIDS tests and condoms. Put the odds in your favor.
Kangol
Condoms if properly used have a low failure rate.
Truvada used properly by otherwise healthy people probably is one of the safest ways to have sex.
Condoms used with Truvada probably are nearly failsafe.
Getting tested is also absolutely crucial. What you don’t know could hurt you in the case of HIV.
Christopher Andrew
Eric. Daniel.
Bob LaBlah
Personally I never did believe that it could prevent one from contracting the virus. It sounded more like a way to increase profits and the ignorant fell for it. And to think of the monthly cost of that drug too. I feel sorry for the guy. It wan’t like he wasn’t trying to protect himself or others.
youarekiddingme
@Iver Frank Becklund: Educate yourself….Sweat does not have CD4 Cells! You cannot contract HIV through sweat, urine, etc… This is not the 1980’s Mr. Becklund (and you don’t look old enough to have lived through the era as I did), so you really should have learned the reality of HIV transmission and AIDS.
@surreal33: Home AIDS tests are fine but unfortunately it can take several weeks after exposure for tests to show up as positive on a person who has actually been exposed, is carrying, and can spread the virus to others. Safe sex, Prep, condom, know your partner (no anonymous sex) and don’t be under the influence of drugs or alcohol when you fuck or you might do something stupid…
DonW
ONE case of HIV among tens of thousands of users does not prove that PrEP doesn’t work. In fact, it’s not a surprise to any of the scientists working on PrEP, who have always put the estimate at up to 99% effectiveness, not 100%.
Nothing in medicine, or life, is 100%. Get Lasik surgery and there is a small risk you will become blind. Does that mean Lasik never works?
The real story is not getting reported: the thousands of people who are NOT getting HIV, because it DOES work the vast majority of the time.
youarekiddingme
@DonW: I don’t think anyone is saying it DOESN’T work. I think the point is to be smart about HIV, how its spread, and the best ways (plural) to protect yourself against infection. The bottom line is that condoms are/will always be in the recommended safe sex “tool kit” not just for HIV but for the host of other STD’s that are out there as well…
Tobi
Gonorrhoea is becoming drug resistant too. http://www.bbc.co.uk/news/health-34269315
Alistair Wiseman
Isn’t it convenient that neither the “editors” of Queerty, nor POZ, mentions anything regarding the patients usage, or rather, the non-usage of condoms.
David Southpaw
:/
Damon Robbins
Nothing in this world is 100%. So be safe and use a condom until you are in a committed long term monogamous relationship. And get tested every year at your annual physical exam!
Steven Carter
There goes the Magic Pill
Billy Budd
I always knew it was a fraud. Money-making fraud.
Bret Kall
That’s the unfortunate thing about HIV testing windows. There’s always the chance that you test negative for over 6 months just before starting PrEP, and you have one tiny exposure or it just missed the window because the virus hasn’t had the chance to replicate. It sucks, but it’s the reality of the situation until RNA testing for HIV becomes the standard instead of antibody testing.
Dan Levin
Just going to leave this here since a bunch of misinformation is likely to sprout up.
http://www.youtube.com/playlist?list=PLp4NNVBC5tD5wbnW5M5-WEBhxvoxa7vGI
o.codone
@Billy Budd: Because it’s 99% effective, not 100% it’s a money making fraud? Puh-Leeze.
Brian
How about we stop promoting Truvada? It’s a fake drug in my opinion. It creates a false sense of security in the people who take it. It thus promotes promiscuity when the solution is to stop being promiscuous.
Keep in mind that Truvada won’t protect you from the pathogens that cause syphilis, gonorrhea or herpes, pathogens that are known to cause immune deficiency.
By the way, why does the headline say “gay man taking PrEP daily….”? How do you know that he identifies as gay? Just because a man has sex with men, it doesn’t mean that he identifies as gay and nor does it mean that he should have to identify as gay.
Thumbs down to Truvada and thumbs down to the buffoons who take it.
Brian
@Kangol: You could avoid going through all those points by simply saying “stop having promiscuous sex with total strangers”.
Simple, ain’t it?
Corey Eymann
considering how many gay men are now on truvada and rarely use condoms because of it, myself included, this is one of the first cases of a person becoming infected when taking the drug daily our of how many tens of thousands? Studies have shown condoms to be anywhere between 70-90% effective while truvada is close to 99% if taken every day. I’ll stick with the blue pill
Realitycheck
Bha! Truvada cannot protect from blood to blood infection, especially if the HIV positive guy wan’t taking medications, there is also the question if the “infected” was really taking his medication as directed…….or if he was high on meth and a heavy user at that, drugs will lower immune response, and kill ya!
As always common sense and caution apply, there is no 100% protection against anything…….
Ray Harmon
A Truvada-resistant strain of HIV is going to get past Truvada. Logic 101. Calm down.
CivicMinded
Seems to me that the widespread use of Truvada will create an opening for strains resistant to Truvada to flourish similar to the way antibiotics allow drug resistant bacteria to become “superbugs”.
Nick Alexander
This is not a surprise it’s not 100% effective and patients are told that.
Raúl Hernández
And there you have it folks
Rusty Angel
This person could’ve had HIV before taking the drug. It can take up to Ten years before it shows up. Always practice safe sex! Even if your taking Prep. If you “DON’T” like condoms and contract HIV. Thats your own stupidity. Only way to stop the transmission of HIV is by getting tested, and if you test POS. Don’t be going having unsafe sex with million other ppl. Nothing is 100% safe. KNOW YOUR STATUS!
Midtownny1
Medicaid covers the pill for pre exposure and limits you to 60 pills. Otherwise it requires prior approval and it is hard to get. So the notion that it is easy to get it on Medicaid is false.
Realityis
@Corey Eymann: Yeah let’s see how that works out for ya…. why don’t you use it responsibly like Giliad intended it to be used… you are part of the problem in my opinion and why this disease will never go away.
You don’t want to get infected…. it sucks. Believe me.
I love how all of these guys who promote raw, bareback sex don’t want to admit it’s finally happened and bound to happen to more and more people. The guy who infected this poor man is probably infecting a lot more than just him…. Open your eyes.
Daniel Vasquez
I recommend prep and condom use to all my friends. we have two important tools for prevention and they can be used in combination. why we are not doing it baffles me. We could get rid of this virus in a decade if we are smart. why aren’t we smart…?
Tackle
I have always been skeptical about this product because it was never shown that it was effective against those who are more likely to pass it on, the newly infected, or those with a “high” viral load… Even someone who is not on Truvada has a very low risk of contracting HIV if the person they have been unsafe with has a low viral load.
Blackceo
Bloop!!!! And there it is. Of course nothing is fail-safe but in the choice between condoms and a pill for which there are no longitudinal studies about side effects, I’d be riding condoms out til the day I die or could no longer get it up. To each their own but NOAP…I have been fortunate enough to have the option of not shoving a pill down my throat every day and I don’t even trust myself to do it every day. I’d be one of those “oh I forgot to take it today” because I’m just not about that lifestyle.
Kangol
@Brian: “Promiscuity” has nothing to do with it.
You can have as much sex as you want, but if it’s safe(r), you have far less to worry about than if you have sex just once but you don’t know your sero-status, don’t know the sero-status of your partner, are not in good health, and use no protection (Truvada, condoms, or anything else).
This is not a moral issue, but a medical one.
DCguy
So one person gets it and now all these posts come out about how it’s fake and doesn’t work?
More straight people than that get pregnant while using condoms so I’m assuming their failure rate is at least as different.
Stached1
Nobody should be surprised by this. Especially since how a lot of people who are on Prep/Truvada do not use condoms or practice safer sex and think it’s 1976 and not 2016, and have the foolish and dangerous mentality that they are invincible and can bareback with whoever they want without getting HIV and other STDs.
@Ray Harmon: Very true.
Paco
@Kangol: The problem is that there is a great number of gay men being promiscuous without being safe. We know the result of such behavior but continue to bury our collective heads in the sand about it. PrEP works and is effective, until you are unlucky enough to have sex with someone that has a strain of virus resistant to it.
passingthru
The safest bet is no sex at all. I think that we can all agree that this is not a good option. If you’re going to play cards, it’s best to stack the deck in every way that you can to try to keep from losing. Truvada and condoms seem to be the best combination at this time. Everybody has to figure out their own way but the more options that we have available to us the better.
Juan Torred
Obstinance from risky behavior always practice safe sex works! sorry to hear a about this ð???
Realityis
@DCguy: Pregnancy doesn’t kill you… we have heard about one person, but the guy who infected him is infecting others most likely….
I can’t anymore….
Bromancer7
I always enjoy a PrEP article that brings out the ignorant slut shamers in droves. Gives me a great laugh every time.
Stache
@Realityis: He is using it responsibly. Very few use PreP and a condom yet this is the first time I’ve heard of it. Plus, every study up to this point confirmed that it was 100% effective. Then a rare resistance strain happens proving only that it’s not 100%. Just like condoms.
Using PreP alone is still far more effective then using condoms alone and no one gets all judgey on them.
Stache
@Bromancer7: Trust me. This is like an early Christmas for them. They would be having full on orgasms if guys were getting HIV in droves.
Paco
@Stache: The virus tore through our community because of unsafe promiscuous sexual behavior. The fact that there is now virus out there that is resistant to Truvada raises real concerns about the future effectiveness of the drug for people that still refuse to use condoms or moderate their sexual behavior.
The only sluts being shamed are the irresponsible ones that still don’t get it. Using PrEP without the recommended addition of condoms while still engaging in risky behavior is what will be the downfall of the drug as a viable option in the future as the resistant strain continues to spread. The virus doesn’t become resistant to condoms making all condom usage irrelevant if one condom fails causing infection. The same can’t be said for failure and infection due to drug resistance.
They need to develop a drug for PrEP that is not available as a medication to infected individuals so the possibility of resistance is even less.
Stache
@Paco: I go by statistics and not just one guy who was unlucky to of hooked up with a drug resistant strain. This means absolutely nothing in the grand scheme of things.
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
DCguy
@Realityis: You stated”” “Pregnancy doesn’t kill you… we have heard about one person, but the guy who infected him is infecting others most likely….I can’t anymore….”
I can’t believe that you just make statements so completely without any supporting facts.
Reality check, In 2013 18.5 women died in the U.S. during childbirth for every 100,000 births and since there were 3.93 million births in the United States in 2013 that means that approximately 3,930 women died from being pregnant.@Realityis:
Vortece
@Stache: You’re not being slut shamed. I don’t care how much sex happens between gay guys, I only want to see them survive. The failure of Truvada in this case is the predictable result of what happens when a PrEP user is exposed to a resistant strain of HIV. Truvada can’t protect you from that infection. But a condom can. That’s why you use BOTH. If you don’t, then the only strain that’s going to be passed around is the Truvada resistant strain, and you’ll see Truvada become completely useless both as prevention and a treatment. Don’t let that happen. Have all the sex you want, take your PrEP and use a condom before we squander the reprieve these drugs have been for our community.
Stache
@Vortece: Except no one is going to do that. The genie is out of bottle. Again, PreP is far more effective then using condoms alone so why the judgement on using PreP by itself? When someone gets HIV from condom use are you going to suggest people stop using condoms?
If you want 100% safe just don’t have sex period.
Paco
@Stache: well judging from the history of how the virus interacted badly with our promiscuous culture of raw sex, I can only sit back and hope the community is not setting itself up for yet another epidemic of infections because they have convinced themselves that the virus can no longer touch them. Deny, ignore, bury heads in the sand all you want, but there is real reason for caution where this virus is concerned. Let’s hope the short term gains hold up and are worth it in the long term.
And please quit comparing condom failure to drug failure due to resistance. Resistant virus is far more dangerous if the people with it continue to insist on raw sex with others.
Vortece
@Stache: People will either use condoms with their PrEP today or use condoms alone 10 years from now then we no longer have effective prophylactic medications to use for back-up. PrEP may be more effective than condoms alone, but it isn’t as effective as PrEP + condoms, and there is absolutely no reason we can’t advocate for both. The only cost is a slightly less satisfying sexual experience and the benefit is saving a life.
Oh, and for the record, when people get HIV from condoms alone, I’ll continue to recommend what I do now: Condoms + PreP. It’s the most effective way a sexually active person can protect himself from HIV. That’s not judgement, it’s good advice.
Stache
There are over 50,000 people on prep today and after 3 and a half years this is the very first documented case of this ever happening. Get a grip people.
Brian
@Kangol: Promiscuity with healthy people is fine but promIscuity with unhealthy people is risky.
In the sexual marketplace, there are both healthy and unhealthy people. If one chooses to be promiscuous in this marketplace, one is morelikely to catch an illness.
youarekiddingme
@Stache: I agree. This is the first case of “this” happening. I agree that Prep is an awesome drug and should continue to be used by folks who are sexually active. No “slut-shaming” on my part. I do disagree with statements about the genie being out of the bottle and folks won’t use condoms as a result of this discovery. BAD DECISION! Not because Truvada or Prep doesn’t work either…
Here’s a whole host of reasons to use a condom (please…everyone, no lectures on percentage of failure of condoms) IN ADDITION to Prep:
Chlamydia
Gonorrhea
Genital Herpes (Herpes is for life–no cure)
Hepatitis
Human Papillovirus
Syphilis
Trichomonisasis
Lymphogranuloma Venereum
*(If there are spelling errors…sorry)
Even with a 30 or 40% failure rate or whatever someone wants to quote, it’s still better protection against all these STD’s (which are becoming more and more resistant to antibiotics). Condoms saved many, many lives during and after the AIDS pandemic so they ain’t that bad! Many of us had lots of sex using them and folks can continue to use them with the added safety of Prep.
scotshot
@Brian: And a big thumbs down to Brian who is an idiot.
smh
Realityis
@Stache: Stache and DCguy = Parts of the problem and the reason this disease is not going to end unless a cure is found….. you both say the same thing every time, but neither of you are untouchable…
Use the shit the way it’s intended or don’t use it at all. The guy who has the resistant strain is probably, unknowingly, infecting more guys who are on PrEP and soon enuf it will be useless.
I am positive so I speak from experience. I say F*ck PrEP. I want a Cure. I am sick of pharmaceutical companies reaping the monetary rewards off of the negative population, especially because these same meds have messed me and so many others up with the side effects they offer.
Oh and DCGuy, sadly and unfortunately the women you speak of died during childbirth (your words), NOT because they took a birth control pill. So your rebuttal doesn’t hold water. Sit down.
BadBoyTKF
I haven’t read all the comments on here yet, so perhaps someone has already posted a similar comment. Why in the hell would you take PrEP and think it’s okay to have unprotected sex? Obviously this person wanted to take precautions and started on PrEP to help prevent contracting HIV, so why wouldn’t he use a condom? I just find so many people who prefer/demand bareback sex. Are people wanting to become infected? Are some people really this f*king stupid? Guess so.
Bromancer7
@BadBoyTKF: PrEP is statistically better at preventing HIV transmission than a condom. This is fact. So your ignorant slut shaming statement has zero merit.
Replace “PrEP” with “birth control” and “HIV” with “getting pregnant” and read your statement back to yourself so you can see how utterly stupid it sounds.
Stached1
@Paco: Well said. Ignore the troll Stache, he’s a brain damaged tweaker that’s HIV+ and into barebacking and spreading HIV strains and STDs.
Daniel-Reader
Seems like everyone here shares the goal of keeping people happy and healthy no matter their situation. So that’s a good thing.
youarekiddingme
@Stached1: Seriously? You’re still going after Stache? I don’t know either one of you. Don’t necessarily agree with everything either of you say. That being said….your comments on him being HIV+ are really no one’s concern but his own. You’ve been talking about him having AIDS and now being HIV+. Do you even know who he really is? Where he lives? By the way, I lived through the pandemic and it’s nothing to make light of and nothing to use as a whipping post even if someone has the misfortune to have contracted the virus. Who is the one who has the problem here?
Another question for you. Who is the one with the diminished mental capabilities here? Is it perhaps the one who comes onto this forum and copies another persons’ screen name and adds the number “1” to the end of it (because of his lack of originality)?
I believe a little introspection is due here?
DerekR
@Stached1: LOL your capacity to be a lying, obsessed, judgement, POS is simply amazing. I think it’s time for another name change. Could I suggest POS1, TotlLoser, ImmaDouche, IgnorantAsFuck or MethMakesMyMicropenisHard…
The Tower of Power
@Realityis: There really is no reason why anyone in the USA should be getting HIV unless you are raped.
This virus has been around for 30 years. Use toys instead of having penetrative anal sex. This is what my doctor advises. Not only will it eliminate your risks of getting HIV, it’s also less risky for other diseases.
Get tested together before becoming intimate.
The truth is, many guys do not enjoy anal sex and won’t do it. I am one of them I find that when I try dating men immediately care about whether I am a top or bottom, and I tell them neither.
Stached1
@youarekiddingme: You must be new here. He’s posted about being HIV+, and into barebacking, and about meth use and glorifying meth use for years on this site.
Stache
@Stached1: The only thing true in your trolling Jac*b23 is that I have admitted to trying meth along with other drugs as many others have. I’ve never “glorified it” and only talked once or twice of it in posts concerning drug use. The rest you’ve made up. Never once have I said that I’m Hiv+ and into bareback sex.
Keep it up though. Anyone who’s dumb enough to take someone else’s name and follow them around obsessively is going to be the only one being mocked. You’re just not perceptive or bright enough to figure it out.
Stached1
@Stache: I’m not Jackb23. Yeah you have glorified meth, as you did in the thread about the increase in men in NYC using meth, and you do this whenever the topic comes up. Yes you have posted about being HIV+ and how you like it raw.
Silly queen, I did not take “your name”, and it’s not all about you despite how you have a huge ego. I picked this name as I have used it for decades online since I have a moustache.
youarekiddingme
@Stached1: I guess if you mean 2-3 years on this site (not actively commenting) I guess I am “new.”
Your other issue about HIV+ is still in poor taste…even IF he has “bragged” about it (which is difficult to comprehend) since HIV has affected so many people’s lives in such a horrible way. A little compassion, respect and restraint. Is that too much to ask from the person who is supposed to be the one of higher moral standards?
theszak
The Strategy. BEFORE sex get tested TOGETHER for A VARIETY OF STIs then make an INFORMED decision, google… tested together before sex
PhishMan
The fact that this occured in june of last year and more cases havent been discovered is encouraging. People that are fear mongering this drug simply dont know the facts of the combination therapy or how it prevents the virus from infecting an individual.
They also dont know how this particular mutation can occur, which is why PrEP is not completely fool proof.
This case is incredibly rare. Learn the facts about PrEP. Knowledge is your friend.
You can fear monger all you want, but this form of prevention is the future of curbing this disease until a vaccine is found.
Tens of thousands of people are succesfully taking this to prevent HIV infection.
I challenge anyone fear mongering to come at me with facts.
youarekiddingme
@PhishMan: Facts:
-Prep DOES NOT prevent STD’s including Hepatitis B.
-Condoms are not 100% either (only abstinence is) they at least provide a Second Barrier of Protection against HIV and THE ONLY BARRIER of protection against STD’s.
-An immunization against HIV won’t be the cure all that everyone hopes because of the rapid mutations the virus has already undertaken.
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