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.
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.