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TheBodyPRO.com Covers CROI 2016

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First Case of Failed PrEP: What Does It Mean?

February 26, 2016

Dr. Robert Grant (Credit: Liz Highleyman)

Dr. Robert Grant (Credit: Liz Highleyman)

At CROI today, researchers and providers heard a detailed case study of a man who was infected with drug-resistant HIV while taking PrEP. No study to date has definitively documented a "breakthrough" HIV infection during PrEP with adherence to Truvada, so the report has garnered a lot of attention and concern from community members.

We spoke with Robert Grant, M.D., M.P.H., to give context to the discussion about what this case means for people currently taking PrEP.

Robert Grant, M.D., M.P.H.:

The person claims he was taking PrEP every day and I believe him.

The prevalence of viruses that are highly resistant to both tenofovir and FTC are rare, and are even less likely to be transmitted.  Among 9,222 people taking PREP in trials, this kind of virus was never once seen.

The prevalence of this kind of virus among recently infected persons is less than 1%.  Maybe much less. If PrEP is not fully effective against viruses that are HIGHLY resistant to both drugs in FTC/TDF PrEP, the efficacy of PrEP when taken may decrease from 99% to 98%. Or from 99.9% to 98.9%. Or from 100% to 99%. The decimal points are not certain.

My point is that one chooses whether to focus on the glass 99% full or 1% empty.

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After 32 years experience with HIV research, I have learned to never say "never."

Yet I also think that gay men benefit from feeling safer during sex and I am grateful that PrEP affords that feeling. People who feel safe feel more power, more confidence in the future, and more desire to discover and pursue their deeply felt personal goals. Believing in the future brings powerful social and personal benefits. There is less trauma. This is all good in my opinion.

PrEP works when taken. Very rarely, PrEP with FTC/TDF may fail to provide full protection against rare multidrug resistant viruses. If that happens, HIV treatment is highly effective and prolongs life to normal levels and makes people less infectious.

His viral load on therapy now is undetectable, meaning extremely low, such that he can expect to stay healthy and live a normal lifespan.

This excerpt was cross-posted with the permission of BETAblog.org. Read the full article.




This article was provided by BETA. It is a part of the publication The 23rd Conference on Retroviruses and Opportunistic Infections. Visit their website at www.betablog.org.
 


Reader Comments:

Comment by: JoAnn (Colorado) Wed., Mar. 16, 2016 at 10:54 am UTC
I wonder are people being advised to just use PREP? At 1st when PREP came out condoms were advised with the PREP-impractical and unlikely-probably, but I am just wondering if this is still the advice.
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Replies to this comment:
Comment by: Kevin Paul (San Diego CA) Wed., Mar. 16, 2016 at 3:06 pm UTC
Gilead recommends in their on line literature the use of condoms. They also recommend limiting sex partners but in what I believe to be an orchestrated promotional social media campaign lead by Gilead, gay men are using PrEP to replace rubbers. It is also true that possible "severe liver damage" nor any other side effects, are ever mentioned.
Comment by: Kevin Paul (San Diego CA) Fri., Mar. 18, 2016 at 9:07 pm UTC
Left out my biggest question....Why would 'JoAnn' believe that gay men using condoms would be, "...impractical and unlikely...?" Is she an expert on gay self hatred or maybe Factitious Disorders? She seems to have accepted the passive disregard gay men have towards hiv infection, as emotionally/psychologically healthy.


Comment by: Chad (L.A.) Tue., Mar. 15, 2016 at 10:33 pm UTC
Re: So, he was infected with a drug resistant strain yet drugs are keeping him undetectable? Can
Someone elaborate? What is he taking to keep this drug resistant strain repressed?-----found the answer in related article.
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Please note: Knowledge about HIV changes rapidly. Note the date of this summary's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this summary. For a complete listing of our most recent conference coverage, click here.

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