Doctors have diagnosed a San Francisco man on PrEP with HIV.
The case marks only the third documented occasion in the United States in which the widely-prescribed and lauded health regimen to prevent HIV infection has failed. The announcement came at IDWeek, a conference for members of the Infectious Diseases Society for America.
Doctors diagnosed the patient with a rare strain of drug-resistant HIV in 2018. He began the PrEP program–a regimen of a daily dose of anti-HIV drug Truvada, along with regular STD and blood testing at 3-month intervals–in 2016. DNA analysis taken from hair samples demonstrated that the man adhered correctly to the program without missing a dose of the drug. Rather, doctors have linked his infection to an HIV+ sexual partner who had stopped taking his own medication.
Related: Man tests positive for HIV while taking PrEP
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The patient’s sexual partner carried a rare drug-resistant strain of the HIV virus, and as his viral load began to increase, he passed it along to his partner on PrEP. The levels of Truvada in the PrEP-taking-partner’s body were not high enough to combat the drug-resistant form of the virus. The case marks the fifth documented case of a man on PrEP acquiring HIV despite adhering to the parameters of the regimen.
It’s important to note that despite this new case of PrEP failure, PrEP remains more than 99.9% effective in preventing the transmission of HIV–far more effective than other methods like condoms. Dr. Robert Grant, of the University of California San Francisco, upon hearing of this new case, assured the public that PrEP remains highly effective. “We know PrEP is greater than 99% effective,” he said in a statement. “There are some cases where HIV will break through. We only have a handful of cases now, and next year, we’ll probably have a handful more. Fortunately, these cases are caught early, treated, and suppressed quickly. The person goes from taking one pill a day to one pill a day. The biggest difference is stigma.”
An estimated more than 350,000 people use PrEP worldwide. The drug is widely credited with reducing rates of HIV infection, particularly among gay men. It still remains the most effective method of prevention against HIV.
Geeker
Wrap it up, people!!!
jimontp
That didn’t really work all that well from the early 80s until the 2010s did it? Don’t be so simplistic. You might as well call yourself Nancy “just say no” Reagan. PrEP is the only thing that is over 99% effective.
Kangol
@jimontp, actually, condom use was quite effective from the “early 80s until the 2010s”; the problem was lack of condom use and improper condom use. Condom use with PrEP is more effective than PrEP alone, as HIV educators will stress. The problem is if you encounter a drug-resistance strain of HIV while on PrEP, you’re out of luck. And if the person also has any other STIs, you have no protection at all without a condom. So yes, PrEP but wrap it up too.
Mozo83
Thank you, Kangol, for corrected lunatic StraightArrow.
rrrick
Literally in the article…
“It’s important to note that despite this new case of PrEP failure, PrEP remains more than 99.9% effective in preventing the transmission of HIV–far more effective than other methods like condoms.”
thewalrussaid
As someone who has had rectal gonorrhea, I strongly recommend combining PrEP with condoms.
Billy Budd
I don’t believe in PrEP. I would never take it. I had periods in my life when I was promiscuous and I never got positive, because I was always very careful.
Creamsicle
Do you not believe in its efficacy?
Kangol
You were very lucky, especially if you were having anal receptive sex. But to the larger point, PrEP is extremely effective in preventing HIV transmission. Do you just not believe in taking it, no matter what? (And you don’t need to be promiscuous; you can seroconvert to HIV+ from just one sexual encounter if you’re having raw sex with no protection at all.)
Umoja
You don’t believe in reducing your risk profile by 99.9%?
Remember, this does not mean that there is a 1/1000 chance of developing HIV. Instead, the 99.9% reduction is on the 0.62% chance an uncircumcised man has of becoming infected (0.11% if uncircumcised).
This means that while on PrEP the chance that you will seroconvert as an uncircumcised man is 0.0006%
What is not to believe about this?
Scout
Nothing is 99.9% effective! Wake up people!!! Don’t be stupid because you want to have sex au natural. Use a condom with Prep. Better yet, save your money and just wear a condom!
Chrisk
It’s more effective than condoms and nothing is 100% Dipshit.
Creamsicle
HIV is a disease. It is not God punishing people for their sins. You could contract it from an accidental needle prick. You’re a piece of shit for judging someone for using one of many tools to avoid contracting the disease. There is also no indication in this post that this patient was not using condoms with his partner.
Sam
Actually, Prep is a lot safer than wearing a condom to prevent. 3 out of 350,000 got HIV(prep user) vs. 3535 out of 350,000 got HIV(condom user) of odds. I calculated that condoms are 98.99% effective against HIV or STD, but 0.8 percent and 40.7 percent broken condom that condoms can break.
1898
i’m sure that’s really comforting to the prep/truvada users who get drug-resistant syphilis, drug-resistant gonorrhea, or anal warts that have to be surgically removed but keep coming back again and again…
Creamsicle
@1898 PrEP patients are all instructed to use condoms in combination with PrEP. No medical organization has officially prescribed the use of PrEP without condoms. People do it anyway, but they have been advised of the risk, and they’re required to get STI screening every 3 months, and while that may be cold comfort, they were informed well in advance of the choices that they made.
The only 100% effective way to prevent STIs is to abstain from sex and sexual contact completely, but we can look at how effective that message is at preventing teen pregnancy, and know that knew tools, like PreP, are more promising than abstinence lectures.
Godabed
Use a condom with PREP, it’s that simple. But people don’t, which is why STDs in general have skyrocketed, which is something no one likes to talk about.
Vince
We already know that. Can some of you shame queens stay on target for once. This is about a guy using PreP becoming positive. Not getting gonorrhea.
tiduspr
I’ve got a huge penis. So huge and thick, that there isn’t a single condom out there that allows me to get and keep an erection.
As someone that was in a zero-discordant relationship for seven years, believe me, I tried them all. At the end of the day, we simply could not have intercourse – you think “love will keep us alive” , but that’s just not realistic.
If PREP would have been around back then, we probably would be together. Even when committed in a monogamous relationship you just never know what your guy is doing. And what, are you expected to use a condom with your husband? Even if that means not being able to have sex at all?
Bitch, please. Stop slut shaming people on PREP. Whether they are promiscuous or not is none of your concern. PREP is a life saver, whether you have one partner or many.
1898
@tiduspr really? there’s not a condom on earth that fits your freakishly big D, but your partner’s butt handled it just fine? rrrrriiiiiiight
jimontp
Slut shaming is really offensive, and in your case is TOTALLY ass backwards. It was the Positive guy who didn’t take his meds you might direct your vitriolic diatribe at.
Using condoms while on PrEP is a valid way to prevent other STIs. But what the hell is “abuse their sexuality”mean? Guys on PrEP are precisely those men who are concerned with their own AND their partners’ well being. You obviously have no compassion or humanity to say “they deserve what they get.” Shame on you. If the positive guy had taken his meds and been undetectable, HE could not have infected his partner. All this moralizing from “straightnNarrow” uninformed gay men is depressing.
Almost all strains of HIV are resistant to some drugs. Did you know that?
Now with multiple drugs available, and the early testing this guy got, they can put him on other meds that he is not resistant to. Did you know that?
Did you read the UCSF doc who said the guy on PrEP would now change from 1 pill a day to 1 pill a day? Do you understand that there are now 3 HIV meds combined into 1 pill a day? Did you know that? I suspect you are totally uninformed about how HIV is treated and prevented these days. Get informed before you spout out your ignorance and hatred.
Brian
How can a hair sample prove that the patient never missed a single pill? I’m skeptical that the science is that precise… it sounds like an impossible level of precision.
I continue to believe that at least some of these cases are of patients who miss doses, then either they forget they missed it or they’re lying. We should all be wary of supposed “silver bullet” medicines, of course, but also be wary of patients who pretend they’re literally perfect.
duje_buric
Everytime a new case like this happens, it is analyzed in details. Which means that aside from hair test to see if the drug was taken regularly, tests to define a virus strain are taken as well. In all five cases so far it has been proven that the virus strain was resistant to Truvada which means that it is completely irrelevant if was taking truvada regularely or not. If he was infected with Truvada sensitive strain that we would be able to discuss if he was or not taking it regularely.
In this case, it is a bit different because the strain was resistent to one component of truvada (emtricitabine) and sensitive to the second (tenofovir) so basicaly the dose that was prescribed was not big enough to protect him.
The hair test is wrongly described here. It is not the DNa from folicle, it is the drug that is accumulated in the hair as it grows. the methods of detection today are very detailed and can follow the drug usega up to 6 weeks back with high certainity.
Creamsicle
Hair drug tests have amazing resolution. As long as the hair was present when you took the drug, it will show up on a drug test if they use hair. Something more familiar, like a urine test, can only detect relatively recent drug use, and it largely depends on the residence time of the drug being tested.
Prax07
I never bought in to the “fact” that prep prevented you from getting hiv, and this article just proves that.
And still blocking guys on apps that advertise their prep use for potential hookups. Still think if you need to advertise that you’re on it then your probably too promiscuous to be bothered with.
EZinHTown
Judgemental much? Better to be on PrEP and use condoms than condoms alone. But clearly you pre-Judge anyone using PrEP as a slut having unsafe sex. I’m guessing you don’t get many second dates on the apps
merp
I’m on PrEP, ‘advertise’ that I’m negative on PrEP and still require that a guy wear a condom. You were saying…?
NateOcean
merp, that’s for being responsible. Several that I’ve dated recently want me to top them bareback because they are on PrEP.
HereIAm
Exactly. These PrEP sluts take a pill and then indulge in unsafe sex. Typical.
Vince
@merp. In my experience that’s a rarity though.
Franklin
@Tiduspr I think we need pics to verify the veracity of your claims. 🙂
Paco
PrEP is a life saver. PrEP used with condoms is even better. STD rates are skyrocketing and it is only a matter of time before the antibiotics used to treat them are no longer effective. There is already evidence of this happening.
rrrick
Are these comments not moderated? StraightnNarrow is being pretty abusive IMO.
startenout
I agree. Sometimes, I think these troll accounts are actually employees for or created by Queerty to keep people coming back to their comments section to stand against them. Regular people’s posts get deleted for faaaaar less.
Toofie
Yeah it’s getting s bit much.
Jack Meoff
So many ill informed comments on this thread that it is a representation of the problem out there in our community and the attitudes and misinformation that abound. Always looking for the easy fix to absolve responsibility or misinterpret facts to allow ones self to do exactly what you want and assign blame for any potential consequence elsewhere.
jpcolter
There is no such thing as abusing ones sexuality. Stop making up nonsense to try to sound clever. You don’t.
EZinHTown
You are a sad self hating human being. Please get some help.
EZinHTown
Look, they do tell you to use condoms even with PrEP. 25% of single gay men don’t use condoms, according to a Queerty article which I have not had time to read yet. Anyway, for that 25% who don’t use condoms PrEP is quite effective in preventing HIV! They weren’t going to use condoms with or without PrEP, at least most of them didn’t and weren’t going to so taking PrEP for those who weren’t using condoms anyway is quite effective.
startenout
You’re literally not worth it.
Prax07
I was saying You’d get blocked even before we’d ever have messaged since you say you “advertise” that you’re on prep. Doesn’t matter if you use condoms too. The fact that guys think advertising they’re on it is a good thing is laughable to me. It’s a drug for sluts, simple as that, and one that doesn’t work apparently.
Nightman
For those who think PrEP doesn’t work, examine the information & statistics. Show me one drug that is 100% effective in stopping the disease or infection it’s designed to do! Measles vaccine? HPV vaccine? Polio vaccine? Small Pox vaccine? Antibiotics? Chemo therapy? Etc. None of them are 100% effective for 100% of the users. Humans evolve, (although some still seem to be stuck in the dark ages) so do diseases. I’m on PrEP & I state so in my profiles. If you want to call me a slut, I thank you for your compliment. I’d rather die having had lots of sex & using a drug I know protects me & my partners 99.9+% of the time, than a born again virgin! I urge others to get on PrEP too, to help eradicate HIV. I support using it simply because it reduces my chances of getting the most common type of HIV in N. America. In the article above it stated the patient caught a form of HIV that PrEP wasn’t designed to prevent. The patient contracted the infection from a different form of HIV.
PrEP DID NOT FAIL!!!
If anyone is to blame it’s the guy who quit taking his meds & went out infecting ppl. He showed a total lack of morals & ethical behaviour & committed socially irresponsible behaviour. I call it assault with a deadly virus that he knew he had & that he knew was resistant to PrEP & he knew he had to take medication for; & he knew he’d quit taking his meds & he willingly had unprotected sex with someone. It is clearly pre-meditated behaviour to assault someone. There is no excuse for that type of behaviour. Lay the blame where the blame is due. Quit “Witch hunting” innocent drugs that do their job. Fear mongering is also unethical & immoral & unacceptable behaviour.
duje_buric
Just to add on your statement that human evolve and so do diseases. Hiv is one of the fastest evolving viruses. It is considered that 1 in 100 HIV viral particles is genetically changed…
Creamsicle
@duje_buric While what you say about the rate of HIV’s mutation is true, it’s still true that the vast majority of mutations are not beneficial to the organism. Meaning that most of those variant mutations are self-terminating and don’t go on to create new variant infected populations.
NateOcean
One guy’s online profile proclaimed that he was HIV+ *and* on PrEP.
Rather confused on that one.
Vince
Could be we’re just saying they’re on meds.
NateOcean
Nope, he mentioned PrEP specifically.
I had to read up on that.
PrEP is COUNTER-INDICATED if HIV+.
Some significant side effects.
HereIAm
Can you believe anything people write about themselves on their profile? People will lie about taking PrEP in order to have dirty and unsafe sex with anyone who is willing to be their victim.
HereIAm
The guy who quit taking his meds, we don’t know why he stopped the treatment, It could be that his body couldn’t bear the side effects of the drugs. It is harsh and unfair to accuse him of assaulting a slut just because they both had unsafe sex. Who knows how many other guys this slut has been sleeping with before he got HIV?
Vince
That’s a good point. I’ve known my share of sluts who got HIV and absolutely know for sure who gave it to them and I just laugh. Please girl. That’s like looking for a needle in a haystack.
I’m all for prep and if you want to be a slut so be it. However I know many people that are doing the it are usually the ones advertising it and get around if you know what I mean.
Kieru
> The guy who quit taking his meds, we don’t know why he stopped the treatment, It could be that his body couldn’t bear the side effects of the drugs
Unless this person informed his sexual partners not only that he was HIV+ but that he was no longer taking medication to manage his status, I would argue that any context as to why he stopped taking the medication is irrelevant.
Kieru
PrEP is not a magic pill. It has conditions that must be met for it to provide protection from HIV.
– The type of HIV must be HIV-1. This is the most common type in the United States but it is not the only type. PrEP will not work on other types of HIV (like HIV-2, etc).
– The HIV strain must not be drug resistant to the medications that make up PrEP: Emtricitabine / Tenofovir. PrEP will not protect patients from drug-resistant strains.
PrEP did not fail here because PrEP is not designed to work here. This illustrates why Gilead strongly urges patients to continue condom usage. If you do not know your partners HIV type or whether it is drug-resistant you do not know for certain that PrEP on its own will offer you enough protection.
If you’re not sure wrap it up. If you are sure then by all means enjoy your condom-free sex because you’re doing so fully-informed.
HereIAm
Just how many HIV+ guys know their HIV type? 1% or lower? And how do they know? This shocking information confirms that if you take PrEP just to sleep around, one day you’ll get infected by an HIV-2 virus.
Kieru
The number you’re looking for is more like 100%.
When a person is diagnosed with HIV the first step is to find out what type it is and whether it is resistant to existing anti-retroviral therapies. This is needed in order to come up with a treatment plan to manage the patients viral load.
As to the ‘how’ of it all: Science!
Dymension
Well, wrapping it up certainly worked for me!
surreal33
Please guys
1) Assume every man you have sex with has some type of STD
2) Oral Quick home HIV test (private, takes 20 min, cost $30 bucks)
3) Condoms are MANDATORY regardless of test results
I can’t co-sign on Prep because no one has addressed the side effects such as kidney disease/failure and liver disease.
Kieru
The side effects you claim no one has addressed have been addressed on numerous occasions. But let me add another occasion to your list.
All medication used to manage a persons HIV status can place a strain on a the liver and kidneys. Since most HIV+ patients take one or more drugs daily to manage their status and do so over the course of their life, they are at a higher risk of developing liver or kidney issues as a result of long-term use.
Because of this Truvada must list a known side effect being liver and/or kidney issues.
The blood test you take while on Truvada is to ensure that your kidneys and liver are operating in a health manner, because while the risk to an HIV- person is low, additional factors (genetic preconditions, general health, additional medications, alcohol consumption, etc) can put you at greater risk. When you first start taking Truvada you are required to have this test performed every 3 months. Once you’ve been on Truvada for awhile (I believe 9 months or 1 year) you and your doctor can decide to have the blood test performed every 6 months, provided your tests have come back showing no risk of liver or kidney issues.
For a vast majority of PrEP users the test will be nothing more than at worse a nuisance, and at best a reminder to renew their medication.
o.codone
If you’re on PrEP doesn’t that mean there’s no longer any such thing as “unsafe” sex? PrEP makes barebacking risk free. Doesn’t it?
Kieru
No. PrEP protects against non-resistant strains of HIV-1, it is up to 99% effective under these conditions, even better if your partner’s viral load is undetectable. But it doesn’t protect against anything else. Drug-resistant strains, HIV-2, and literally any other STI are all fair game.
If you don’t know your partners status or whether they have other STIs wrap it up.
Dfl70
Wow you guys in the states have some very ignorant views towards prep and safe sex! The rest of the world looks on prep users as people doing their bit for the greater public health… Yet many on here many slut shame and spread mistruths. What has happened over there. You used to lead the world!