For the first time, researchers have documented a case in which an individual taking Truvada daily as a preventative measure from contracting HIV has contracted a multi-drug resistant strain of the virus.
That man — 44-year-old gay-identifying “Joe” — had been on PrEP for two years before contracting HIV.
He spoke with POZ about his experience, including making international headlines after his diagnosis.
Below are some excerpts from that interview — head here to read the full article:
On how he reacted to taking the pill:
My body tolerated it well. And I have an app on my phone called Mind Jogger that reminds you to do things. I programmed it so that between 11 a.m. and 1 p.m., it gives me 10 notifications to take my medication. My logic was that no matter what day it is or where I am, I will be awake between 11 and 1.
On his adherence to the daily regimen:
I was on it the entire time. A lot of people disco dose [take it only during risky periods] because of the cost factor. When I took it, in Canada, Truvada was prescribed off-label as PrEP, but my work benefits covered my medication so, for me, it was not a problem. And to be honest, I don’t believe in disco dosing because I think it’s better to maintain the same level of medication in the bloodstream.
On whether PrEP affected his condom usage:
Oh, yes, definitely. To be honest with you, I stopped using condoms after going on PrEP. I was such as big proponent of PrEP that if I was chatting with someone on a hookup site who wanted to use condoms, it was a deal-breaker for me. I was having sex to enjoy it. And if I was wearing a condom or the other person was wearing a condom, I wouldn’t enjoy it.
How he initially learned of his diagnosis of HIV, later explained as a rare strain of the virus that is resistant to multiple drugs:
On May 4, I had the regular quarterly blood test for HIV and STIs [sexually transmitted infections] and kidney and liver function, and all that. On Friday, May 8, at 6 p.m. my doctor gives me a call at home and says, “Joe, your p24 antigen came back positive.”
I said, “OK, what does that mean?” And he goes, “You’re HIV positive.” And it was…it was a bit of a shock. I said, “That can’t be, there’s no way. Are you sure it’s not a false positive?” He said that in 90 percent of cases where the p24 antigen comes back positive, the person is HIV infected.
On the man he thinks gave him the virus:
Here’s the story. He’s in a relationship and “discreet.” We met on bbrt [a bareback community], and he says he’s negative. I prefer to be with people who are positive and know it and are on meds—I’m on PrEP, you’re undetectable, the chances of transmission are like negative 10 percent—but I broke my rule with this guy. So it was with him, I think—it was a bit of a busy period. I reached out to him and he says, “Well, I’m not worried, I’m OK. But I’ll go see a doctor.” And I checked in with him again: “Have you gone? What are the results?” “Oh I’m really busy and haven’t had a chance.” I checked in again. “Oh, I’m out of town on work.” Checked again, and he stopped replying to me. To be honest, I gave up. I don’t need to be vindicated or have him say I’m sorry or whatever. I just wanted to let him know. It’s being socially responsible.
On his involvement with the flurry of press:
Normally, I’m involved, but I try to stay away from the social commentary regarding this announcement. There was someone, a Facebook friend, who made a blanket statement about, “Enjoy your AIDS, PrEPsters.” I don’t know if it comes from fear or hatred or whatever, but some people feel vindicated that PrEP is not 100 percent. And it’s the Internet, right? Everyone’s got an opinion. To be honest with you, I’ve been focused on work; I applied for a new position, and there are a lot of expected changes. It’s been good.
Takeaways from his experience and why he wanted to share his story:
Because knowledge is power; the more we know, the better we’re prepared. PrEP’s a calculated risk. It’s important for people to know that there is the possibility as opposed to the fantasy that there have been no recorded infections on PrEP. At least now there is one, so it makes it more real. And I tell people, “It didn’t work for me, but I still think it’s great.” If I had to do it all over again, I would still go on PrEP. I just wouldn’t have sex with that specific person.
On the news that Canada recently approved Truvada as PrEP:
I was relieved. I thought, “Finally. It’s approved!” As PrEP becomes more mainstream, there will be more awareness. Doctors will know more. Patients will know more. Many of the myths will be dispelled. And more people will have smart, as well as safe, sex.
To read the full interview, head to POZ.
The problem I have with this is PrEP is now being perverted into advocacy for raw sex. It is becoming an either or situation between condom usage and PrEP. Even if Truvada remains mostly effective as PrEP with barebackers, the already sky high rate of other STDs between MsM is going to skyrocket further.
How long before condoms become a deal breaker for almost everyone on PrEP, just like the guy in the article? You will soon be shamed for wanting to be safe from all the other infections PrEP doesn’t protect against.
@Paco: “the already sky high rate of other STDs between MsM is going to skyrocket further” and some may become untreatable. http://www.bbc.co.uk/news/health-35153794
What people need to get through their heads is that, much like birth control, PrEP isn’t an excuse to abandon condoms. PrEP is meant to be used in conjunction with regular condom use as a back up in case of accidents or failures.
If you’re stupid enough to put a chemical like PrEP in your body, go right ahead. It won’t protect you. You’re only making the multi-national drugs companies richer.
If you need to put chemicals into your body, there is something wrong with you in the first place. You need to re-assess your life, your values, and your priorities.
Now he will DIE sooner than expected and can take his PREP in heaven. Prep is a fraud.
And this “victim” is probably right back on BBRT looking for loads stating he’s “undetectable.”
slut shaming… yes. by his own admission, “it was a busy period…” and read between the lines. The C*ck was big and his “reason” went out the window.
Only stupid people take PrEP. Only stupid people don’t use condoms. Only stupid people get HIV.
This is what I have been screaming about the past TWO yrs, and why I believe that PrEP has NOT been shown to work. It has to measured against those who are most contagious/likely to pass the virus on. And that’s someone newly infected, or whose viral load is sky-high. Other than that, nothing is being proven. As I have been saying the past TWO yrs, any healthy person, not on PrEP, and who is having the most risky type of sex with someone with a low or undetectable viral load, is not likely to become HIV positive. And I believe the likelihood is over 83%, of not becoming infected. The Pharmaceutical companies are definitely aware of this. As always, they’re just in it for profit. And gay men are their guinea pigs…
why share your story? “Because knowledge is power; the more we know, the better we’re prepared.” what? WHAT? all the knowledge/power you needed was all over the box, the package, the pamphlet, the internet, your doctor no doubt told you – NOT A SUBSITITUE FOR CONDOMS. I mean come on. I am NOT slut shaming at all- have and enjoy as much sex as you can get and be careful… I am WILLFULL IGNORANCE shaming… I am “oh wait… that’s what that meant?” shaming… This was just a matter of time. “if I was chatting with someone on a hookup site who wanted to use condoms, it was a deal-breaker for me”- oh so you mean you passed on all the folks smarter than you, who read the label and knew to still wear condoms? those are the guys you passed up, huh? making some good life choices there, are we?
People act like PrEP is a fraud or a failure because of ONE infection, among more than 40,000 users. So it’s only 99.98% and not 100% effective. Why do you demand an impossibly high standard that you don’t require in any other area of life?
Seatbelts only prevent between 45 and 60% of traffic fatalities. Oh well, they’re a complete failure, right? Measles vaccine: 95-98% effective. F*ck that, not putting that worthless poison in your body — right?
And you do know that condoms fail too, don’t you? They are less effective than PrEP at preventing HIV, and only partially protect against other STIs. So, by the logic of the PrEP haters, condoms are worthless and people who rely on them are idiots — right?
We have multiple tools for sexual health. Use the ones that are right for you, and stop shaming and name-calling people who make different choices.
@DonW: I agree PrEP isn’t a failure nor a fraud; and true condoms aren’t a hundred percent. That is why PrEP is intended to be used with condoms, the same way as with birth control for women. Condoms are the first line of defense followed by PrEP is and when accidents or failures happen. Yes there is too much shaming in the gay community, but at the same time the most accurate information should be put out there.
@oddchild1: I agree that the ideal would be both condoms and PrEP/birth control (call it “belt and suspenders”), but we don’t live in a perfect world. 1. Very few straight men actually use condoms with birth control pills. Most will tell you why: it just doesn’t feel as good. 2. Condom use rates have never been great among gay men either. So getting them to at least use PrEP is a huge gain.
@DonW: And PrEP is zero percent effective at protecting against other STIs which are becoming resistant to medications and will take a huge public emergency before pharmaceutical companies will decide that new research for antibiotics would be profitable again.
What exactly will you tell the guys that were lulled into a false sense of security ( or pressured into ditching the condoms in the heat of the moment because they are a deal breaker) by the raw sex advocates that are hijacking the PrEP messaging, when they get unlucky enough to have sex with the guy in this article, or the man that infected him and possibly others with a Truvada resistant strain of the virus? Tough luck kid, infection happens?
Since this has made news, there has been little talk about condoms and PrEP together and more opinion pieces using this to advocate for raw sex. Like this is the only STI disproportionately affecting our small oversexed communities that have a lot of overlap with sexual partners.
Completely irresponsible. The 1970s are history.
Aren’t people taking PrEP instructed to use condoms? This guy obviously got the idea that PrEP was a “bareback” drug, which it isn’t, and, guess what? He got HIV. No surprise there.
“Because knowledge is power; the more we know, the better we’re prepared.”
Except when it’s a “busy time” or the guy is like really hot?
I’m bummed for this guy, although I do think he was playing fast and loose with his health, I don’t think anyone wants to be living with HIV and AIDS. PrEP medicine could make HIV stronger because the only strains of the virus it does not work on will be the only strains that continue to infect people. Think about that, the only strains that continue to affect people will be the stains that are drug resistant, 3 years from now that could be a really big medical problem.
I personally made the decision a long time ago that sex was not worth the health risks. Men will lie about their status, lie about who they have been with and even refuse to get tested in the first place, even guys in committed relationships will stray and you can’t be sure who they are playing with or if and how they are protecting themselves. Add to that the growing opinion that HIV/AIDS is a treatable infection and it seems a lot of guys have let down their guard.
The choice to abstain was easy for me, sex feels good, but like most things in life that are romanticized, the reality of sex falls short of the romantic ideal. I realize I’m in the minority and abstinence is not a viable solution for most guys, but we all need to make the best choices we can to protect ourselves, no one else is going to look out for our health, and as men, we know how men are.
Protect yourselves and play safe.
According to a researcher I spoke with you can’t count on PrEP to be more than 80% effective. Until there’s a vaccine or a cure, there is NO safe, unprotected sex.
The timing seems off. (No, not that 11 to 1 bit he mentioned.)
Truvada was just approved in Canada, for everyone who does not have any kind of special insurance, as this gentleman did through his work, on 28 February 2016. It’s still an expensive medication nonetheless, and drug companies prefer to make money (rather than lose it).
@junk4sts: PrEP has been around since 2004 so I think we’d see something like that by now.
@junk4sts: Uh, I think you’re thinking of antibiotics. dude lol. PReP is def not an antibiotic…
There are over 50,000 people on prep and after 3 and a half years this is the first documented case of this happening. One seroconversion means it’s still effective 99.98% of the time just by itself.
Now contrast that to a new study that say half of new HIV infections occurred while using just condoms. http://betablog.org/51-new-hiv-infections-condom-failure-anal-sex-study-finds/
If he was on bbrt, I can tell you that he was probably doing drugs and drinking hard which lowers your immune system and makes you more vulnerable to the virus. PrEP works if you don’t abuse your body with drugs and take care of yourself.
@Stache: I wouldn’t put much stock in a study based solely on mathmatical modeling and is “not based on a clinical study of observed or documented transmission data.”.
@BigG: Ha. That’s an excellent and true point. People that do drugs like Meth are heavy into that site. I know this because in my own drug taking days I was lured over to that site.
@Stache and @Cleverusername, Your points are valid, possibly we’d just see Truvada slowly become less effective over time as HIV mutates.
We each have to determine the level of risk we are willing to tolerate. If you are HIV- you should really do everything you can to stay that way, Truvada is a good tool to have in your HIV prevention tool box, but like any other tool it needs to be used properly to be most effective.
@oddchild1: So am I right in thinking that you are advocating people who use condoms use PrEP, too?
@Paco: But I would in a study that pointed out that, despite the best of intentions, only 16% of self-reported “always” condom users actually managed to always use them at every encounter, over the course of two years. People who want to use condoms all the time have a great deal of difficulty -actually- using them all the time. (http://www.pridesource.com/article.html?article=69483)
Populations that use daily PrEP manage to reduce infections by 86%. (http://www.incidence0.org/2015/02/24/86-risk-reduction-is-it-finally-enough-for-prep-to-be-made-available-in-the-uk/)
Only about 1 in 5 people are able to us a condom consistently. 1:3 people are able to do so with PrEP…. but -inconsistent- PrEP use provides better protection (75-96% reduction) than inconsent condom use (forgetting to use a condom provides zero percent reduction in the chance of infection. Comparing the two then, condoms alone manage to stop 7 our of 10 new infections. PrEP alone manages to stop at least 8.5 out of every 10 new infections.
It not a question of either / or / and. It’s a question of what method people are best able to use consistently to protect themselves.
I don’t believe him.
@Mac Daddie: “According to a researcher I spoke to” is hearsay. Cite a published source for your claim. The CDC links to the major scientific research on PrEP, none of which states an effectiveness rate of less than 90%. http://www.cdc.gov/hiv/basics/prep.html
I hope his story can act as a wake-up call to members of our community that advocate PrEP as a condom alternative, as opposed to a secondary line of defense against HIV.
Honestly this is what would be required for me to consider using PrEP without a condom:
– Knowing the HIV status of the person
– If HIV+, knowing their type / resistance / current treatment results (numerically undetectable? still high viral loads?)
– Knowing any other STIs they may have
That’s the only way you can make an informed decision on whether a condom should DEFINITELY be used, or whether you can rely on PrEP alone. So I guess go-go monogamous serodiscordant couples. You’re the ones that should be reaping the benefits of this drug.
And honestly… are people still bringing up that bareback is the only enjoyable form of sex? Get over yourself. Bareback is nice, but condoms are being made thinner than ever and in sizes to accommodate any length or girth. Slap a rubber on it if you’re not sure; it beats contracting HIV or any other STI.
@Paco: It is indeed irresponsible for anyone to pressure someone into having sex they’re not comfortable with, based on PrEP or anything else. You’re right, I wouldn’t wish for anyone to encounter the guy who infected Joe with a resistant strain. (As for Joe, however, his viral load has been completely suppressed and he is effectively incapable of passing it on).
Like you, I’m very concerned about STIs other than HIV, which have been on the rise since long before PrEP was on the scene. I am also concerned about lulling people into a false sense of complacency that just encouraging condom usage is enough. Most STIs can be transmitted orally or through skin-to-skin contact. While condoms are a necessary harm reduction tool, they are not enough.
What is needed is much more frequent testing and treatment. The PrEP protocol includes STI testing every three months, which means infections are detected, treated, and prevented from further spreading. ALmost nobody who is not on PrEP gets tested that often — and even when they do, it is often inadequate. (It’s amazing how many healthcare practitioners don’t know to give gay men oral or rectal tests for gonorrhea and chlamydia, which can lurk without symptoms but still be infectious).
Comprehensive education about STIs, and low-cost testing, need to be easily accessible for everyone, not just those who choose to use PrEP.
@DonW: Testing can’t really keep up with many of these guys. It would have to be extremely low cost and convenient.
@Paco: What’s the alternative to testing? Scolding them even louder certainly isn’t going to help.
Part of the solution is, of course, partner reduction — not a popular concept, I know. My personal experience is that being on PrEP has resulted in a smaller, known, trusted group of partners. I feel more comfortable with fellow PrEP users or HIV+ undetectable guys who are aware of their status, test frequently for both HIV and other STIs, and are open to discussions about sexual health. (Precisely the approach Joe described, though he unfortunately slipped up on his own rule).
Paradoxically, a lot of fearful, poorly informed men reject PrEP users and guys who are honest about their HIV+ status, in favor of other self-defined negative partners who may have a spotty testing history. That kind of “neg4neg” serosorting has proven itself a lousy safety strategy, since many infections are passed on by newly infected men who are unaware of their status.
Ultimately people are more likely to take the prudent course by free choice than compulsion. Give them facts, options, and access to prevention and treatment — but leave the browbeating and moralizing aside. This approach has long shown itself to be a more effective safer-sex promotion strategy than the kind of holier-than-thou posturing that fills the comment boards.
This case is a rare outlier in terms of science. Being that it is drug resistant, and the occurrence of a drug resistant viral strain is very rare, I think it’s safe to brush this event aside and continue to say that Truvada is 100% effective. Also, if you want to argue with me about it, “what difference does it make” if this case pushes Truvada down to 99.99% effective? Clinically no difference at all. So, let’s not bother to argue numbers. PrEP is still 100% effective in preventing HIV infection. Keep it real.
@DonW: I was just pointing out that there are limits to testing with current technology and economic factors. Yes a lot of guys do reject PrEP users out of fear, but when you have some PrEP users outright rejecting condoms with a person that wishes to be as safe as he can be with a hook-up, can you really blame them for not wanting to have to take a day off of work the following week to go get treated for an STI that a condom probably could have prevented. Depending on the infection of course.
There are many men that have successfully used condoms to remain healthy. Why are they effective for them and not others?
@Paco: Condoms pretty much are shunned by people on PreP as those fools believe that the toxic PreP/Truvada will protect them against all strains of HIV and that they can do it raw with anyone who they want as though it’s 1976.
@Mac Daddie: Very true, it’s not as effective as condoms are.
@Paco: Well said.
On May 4 he has his blood drawn, and on May 8 his doctor calls to tell him (over the phone) that he is HIV positive?
Given a positive result, was there really enough time to send the sample to a second lab for a confirming result?
When I had an abnormally high PSA result, the first words out of my doctor’s mouth was, “repeat the test”. Results were normal, and have been normal ever since. Doctor chalked it up to “lab error”.
@Billy Budd: With that comment, Billy Budd, you have put yourself right on target.
@Paco: “There are many men that have successfully used condoms to remain healthy. Why are they effective for them and not others?”
I can’t say why. Most likely for the same reason that many men successfully go to the gym three days a week, and others don’t, despite the best of intentions.
We have been repeating “use a condom every time” for 30 years — with good reason — but a steady 50,000 people still get HIV every year. Most of them probably really, really meant to “play safe.” Human nature, and lust, aren’t always so cooperative. The thing about PrEP is that it is forgiving. You can miss up to three doses a week and it barely loses any effectiveness. With condoms, all it takes is one drunken slip-up and you have no protection at all.
PrEP offers the first new tool in decades to help reduce the stubbornly high HIV rate. Does it have its pitfalls? Of course. Does it prevent other STIs? No, but it never promised to. (One day, God willing, we will have a vaccine or a cure for HIV. Then we’ll no longer have the AIDS bogeyman to scare guys into protecting themselves against the clap, so we’d better come up with a better strategy).
As for other STIs, while condoms convey substantial protection, it is far from 100%. You can still get most of them from oral sex or skin contact. But most guys (including you, I’m guessing) seem to be OK with condomless c*cksucking. They accept a calculated risk in exchange for satisfying sex. So I’m not sure why so many then turn around and condemn others for making a different set of calculations. Unless they’re opting for the only truly safe course — celibacy — they’re really not in a position to judge others.
What about this article?
This isn’t just one case. PREP is an all too foreseeable disaster on the horizon.
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Honestly, I think all gay men should be strongly discouraged from engaging in anal sex, with or without condoms or PrEP. It’s just way too dangerous.
@Extant: That is resistance resulting from the widespread use of this drug in treatment, including in third world settings where adherence is an issue. This has nothing to do with PrEP.
Bashing PrEP because of resistance developed during treatment is kind of like saying, “Oh we can’t have gays in the Scouts, we have enough trouble with pedophiles.” These are two completely different issues.
@oddchild1: That’s BS. You don’t need to take a drug in addition to condoms. How often do condoms break? How often have youhad a condom break? It’s literally happened to me one time and I’ve had a good amount of sex (being modest) Lol You along with a lot of other naive folks have been drinking the kool-aid if you believe that the drug was created to be used as an addition to condoms in case they break Lol
1) PrEP use in Canada will not increase in any significant way (despite federal Health Canada’s approval of Truvada) until the provinces include it among the government-insured drugs which are covered in each jurisdiction. Most patients cannot afford $1000+ per month for this medication; it’s that simple. And I’m curious about Joe’s assertion that his employer benefits cover his Truvada costs. I have lots of Canadian friends, in several of the ten provinces, and none of them who have private insurance plans (ie. for extended health like drugs) have coverage for Truvada.
2) It’s absolutely correct that one case of transmission among many thousands receiving PrEP treatment is statistically insignificant. There is still a huge benefit for nearly all users who adhere to the treatment regimine. It’s just unfortunate that this single case involves a subject who, through his attitudes, behaviour, and self-righteous stance will fuel the anti-PrEP zealots.
@DonW: So because condoms don’t offer 100% protection from other STIs, people should just ditch them completely and live with the fact that they will just need frequent treatments for STIs if they are very sexually active and only rely on PrEP?
And how about when people that wish to use condoms encounter more and more PrEP users that refuse to use them, and then get called slut shamers when they ask how many condomless sexual encounters have they had since their last full physical, so they can try to make an informed decision about the risk?
@Merv: It’s fine to have anal sex as long as you use a condom and use it correctly. But if you take PreP/Truvada and bareback then you have nobody but yourself to blame when you get HIV and other STDs.
@Billy Budd: Very true. I figure that the people who take PreP/Truvada and do it raw have the mentality that they are eventually going to get HIV so they might as well get started on taking the meds early. People who bareback even though they take PreP are going to eventually get infected with HIV or multiple strains of HIV and other STDs.
@Paco: same shit for the so called immunity genes, when they ultimately they just promoted resistance… albeit resistance to primary strains.
but for as much a waggling finger as one offers here
nobody chastises heteros to the same level when it comes to safer sex and condom usage.. particularly those in relationships.
it’s pretty easy to see where the safer sex blowback is coming from… when so much of it dished by agencies is less sex positive than guilt and shaming.
and of course, there’s other sti to worry about — lesbians still run pretty high for everything else – the correlation to a subset of cancers attached to hpv and other sti — namely because of the belief if they avoid bisexuals, they don’t need to practice safe sex either.
it’s the same ol’ mentality we’ve yet to escape yet because we can’t have a legit discussion in the public sphere or even just the queer community about safe sex, hiv or even the existence of other sti
the moral condemnation is as high in the community as it is outside of it…
@DonW: Either you didn’t read the article or you are being deliberately dishonest. Here’s the very first sentence:
“Resistance to a key HIV drug is common worldwide and could mean trouble for treating and preventing the virus that causes AIDS, according to a new study.”
Here’s two more paragraphs: “For the new study, the researchers used data from 1,926 people in 36 countries who continued to have uncontrolled HIV despite simultaneous treatment with an assortment of drugs that included tenofovir.
The proportion of people with tenofovir-resistant HIV ranged from 20 percent in Europe to over 50 percent in sub-Saharan Africa.”
So how is this article ONLY about use of Truvada in the Third World when the article clearly states that study involved more than 1900 people in 36 countries, tenofovir resistance was 20% in Europe, and that resistance can be passed on?
@DonW: Also, what is the point you are trying to make if you say this is resistance resulting from widespread use? Isn’t that exactly the problem? What do you think PREP is? How is the widespread resistance to the drugs that make up PREP not the same thing as resistance to PREP? What would be the point of PREP if the drugs that make it up are ineffective due to widespread resistance?
I know that is a lot of questions, but I really don’t understand your point. It seems like a distinction without a difference, but perhaps I misunderstand.
@Extant: The article is not about Truvada in either the developing world or the developed world. It is about tenofovir, which is only one of two components in Truvada. Resistance to tenofovir, while it is a major problem for treatment, does not translate to the failure of Truvada as PrEP.
Look, I am not being obtuse or dishonest. I am frustrated that people seem determined to grasp at any possible excuse to discredit PrEP. It is the most important advance in HIV prevention in decades. We need every possible effort to combat this epidemic that continues to devastate our community, and gay men just continue trying to tear each other down for using this new method.
The experts are quite clear about this . PrEP is a key part of a new effort that count make a serious dent in the epidemic. Stop trying to scare people away from considering it.
@DonW: *a new effort that could make a serious dent in the epidemic.
(Pardon the lengthy post — I’m trying to explain thoroughly)
Here’s the distinction between resistance in people in treatment vs. resistance in people on PrEP. Yes, all viruses and bacteria evolve over time and we have to keep developing new drugs to keep up. That is the nature of our battle to share this planet with microbes — it will always be whack-a-mole. New HIV meds, and new forms of PrEP, are in the pipeline for that very reason.
However, resistance can only develop in HIV+ people. Where there is no virus, there’s nothing to mutate. PrEP is by design only given to HIV-negative people. When PrEP works (as it almost always does), the virus can’t take hold in the host. It isn’t there, so it can’t evolve.
There’s some confusion because the term “resistance” has a different meaning when talking about people on PrEP. If someone who is HIV+ improperly takes Truvada (which isn’t enough to treat an infection by itself), resistance can develop — all that means is that Truvada may become a less effective option in treating that individual. PrEP users are tested for HIV both before starting, and regularly during treatment. If an infection is found (usually because the patient was unaware they were HIV+ when they started, or because of poor adherence), the person is put on adequate treatment. The resistance tends not to last once Truvada is discontinued. See: https://www.poz.com/article/PrEP-resistance-28197-2961
The resistance that matters is what develops in HIV+ people because of inadequate treatment. Truvada is used as part of the treatment of more than half of HIV+ patients in the US. It is going face the risk of mutation, and we will face that challenge as it comes. That would happen even if PrEP didn’t exist.
Here’s the thing, though: more people on PrEP does not mean more chances for resistance. It means fewer infections, less virus floating around, hence less chance for mutations.
Does that make sense?
@Periwinkle: This isn’t just about morals. The MsM community is disproportionately impacted by STIs in the US. Telling heterosexuals to wrap it up is going to have no impact on our community with sexual transmission of infection. Yeh it is too bad that the men in our community feel unfairly targeted, but the numbers don’t lie. We do have more sexual partners than other groups on average. That is nothing to be ashamed about, but it does mean we are exposed to things more frequently than others just by sheer volume of sexual partners. It also doesn’t help that our pool of possible sexual partners is also much smaller than for heteros.
Telling a specific community the truth about the statistics isn’t shaming them or not being sex positive. You can have all the sex you want and be sex positive while using condoms that can reduce the number of STI transmissions between people. How do you get the idea that advocating condom usage to a community that the data has proven has many more STI infections than other groups based on the percentage of people in those groups as anti-sex or shaming?
@DonW is right.
Resistance to tenofovir does not correlate to Truvada being ineffective as PrEP. Truvada is comprised of two drugs; tenofovir and emtricitabine. The man who contracted HIV while on PrEP contracted a strain resistant to BOTH drugs, which is extremely rare.
What it does suggest though, is that we would benefit from studies conducted to test the efficacy of Truvada against tenofovir or emtricitabine-resistant strains. It further strengthens the defined uses of PrEP, which is in conjunction with condoms, as opposed to a condom-alternative.
More importantly, it shines a light that we as gay men need to take more control over our sexual health. Whether you’re monogamous or in an open relationship, casually dating or working your way A-Z through Grindr: ask your sexual partners status. If they are HIV+ ask them if they are on medication or if they know their viral load, or if they know what drug-resistance they have.
If they cannot answer those questions throw a condom on to be safe.
@Kieru: Good points. It’s hard to imagine how to design an ethical study specifically to test Truvada against strains that are resistant against both components. What we know at this point is that they are still exceedingly rare. The scientific position is that, for the foreseeable future, the population-wide benefits of PrEP use vastly outweigh any risk of resistance.
The CDC believes that PrEP, along with expanded testing and treatment, stands posed to reduce new infections by as much as 70% by 2020. That’s very hopeful news. But it’s not going to happen if naysayers keep blasting half-truths and casting doubts that discourage at-risk men from considering PrEP.
As for the “defined use of PrEP as in conjunction with condoms”: we can certainly continue to repeat that ideal, but we should be under no illusion that we can change the reality that few gay men use condoms every time. If they did, we would have ended the epidemic decades ago.
Fortunately PrEP *does* protect against HIV even without condoms: of the thousands of study subjects, many were having condomless sex, both before and after starting PrEP (and nothing we tell them is going to change that). Yet, until the Toronto case, not one person who was documented to have been adhering to the prescription got HIV.
Of course condoms would be an additional protection against those rare resistant strains, and they provide partial protection against some other STIs, so they’re certainly still important tools. Many individuals who are capable of using them religiously have successfully kept themselves HIV-. But as an overall public health measure to end the HIV epidemic, they have not succeeded. The annual number of new infections has stuck stubbornly at 50,000 for years. Something new was desperately needed. Shouting “condoms!!!” even louder is not that something.
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