No new HIV infections seen among Kaiser PrEP users

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    Dec 15, 2014 11:05 PM GMT
    Published: 15 December 2014

    No new HIV infections have occurred among more than 500 users of the Kaiser Permanente healthcare provider system in the US in members using pre-exposure prophylaxis – better known as PrEP.


    https://www.aidsmap.com/No-New-HIV-Infections-Seen-Among-Kaiser-PrEP-Users/page/2929303/
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    Dec 16, 2014 12:44 PM GMT
    I was surprised at the small sampling size, and the small number of people they quote on PrEP for San Fran. I would have thought at least 1,000!

    While I'm glad some of the participants were using condoms; I'm certainly worried about the 45% that declined.

    **edit** I also wish they had included adherence rate. That was certainly a concern in the iPrex study.
  • slimnmuscly

    Posts: 541

    Dec 17, 2014 11:11 PM GMT
    From the article:

    PrEP critics fear that a reduction in condom use could lead to a rise in other sexually transmitted diseases (STDs).

    "We are seeing a high numbers of STDs in people on PrEP," Hare acknowledged, but again he stressed that there is no control group of people not taking PrEP to use for comparison.

    These STDs include the "usual suspects" syphilis, gonorrhea, and chlamydia, he said, but Kaiser providers have also seen two cases of acute hepatitis C in HIV-negative gay men who were not injection drug users. Sexually transmitted hepatitis C has been reported among HIV-positive men over the past decade and a half, but it has been thought to be rare among HIV-negative men.


    PrEP does have the potential to tip HIV below epidemic levels, which would be wonderful, but gay men and the AIDS industry have to stop acting like HIV is the only STD that matters. We're in the last few days of the era of cheap, easily treated STDs. We've burned through nearly every antibiotic that once worked, and no new ones are on the horizon, because HIV is where the money is.

    This is where PrEP cheerleaders will jump in and say, "but most of those STDs are easily spread by oral sex," to which my response is: Yeah. Exactly. Maybe it's time to reevaluate your definitions of "safe sex" and your expectations about what should happen on a hookup to account for that fact instead of rationalizing barebacking on PrEP.
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    Dec 17, 2014 11:56 PM GMT
    timmm55 said Published: 15 December 2014

    No new HIV infections have occurred among more than 500 users of the Kaiser Permanente healthcare provider system in the US in members using pre-exposure prophylaxis – better known as PrEP.


    https://www.aidsmap.com/No-New-HIV-Infections-Seen-Among-Kaiser-PrEP-Users/page/2929303/



    Good news for the gay community . Kinda like sacrificial lambs though for the prep users.
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    Dec 18, 2014 1:30 AM GMT
    Really good points.

    slimnmuscly saidFrom the article:

    PrEP critics fear that a reduction in condom use could lead to a rise in other sexually transmitted diseases (STDs).

    "We are seeing a high numbers of STDs in people on PrEP," Hare acknowledged, but again he stressed that there is no control group of people not taking PrEP to use for comparison.

    These STDs include the "usual suspects" syphilis, gonorrhea, and chlamydia, he said, but Kaiser providers have also seen two cases of acute hepatitis C in HIV-negative gay men who were not injection drug users. Sexually transmitted hepatitis C has been reported among HIV-positive men over the past decade and a half, but it has been thought to be rare among HIV-negative men.


    PrEP does have the potential to tip HIV below epidemic levels, which would be wonderful, but gay men and the AIDS industry have to stop acting like HIV is the only STD that matters. We're in the last few days of the era of cheap, easily treated STDs. We've burned through nearly every antibiotic that once worked, and no new ones are on the horizon, because HIV is where the money is.

    This is where PrEP cheerleaders will jump in and say, "but most of those STDs are easily spread by oral sex," to which my response is: Yeah. Exactly. Maybe it's time to reevaluate your definitions of "safe sex" and your expectations about what should happen on a hookup to account for that fact instead of rationalizing barebacking on PrEP.
  • Sincityfan

    Posts: 409

    Dec 18, 2014 6:32 AM GMT
    I still think it's funny that people think prep makes you immune to HIV.
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    Dec 19, 2014 9:19 AM GMT
    slimnmuscly saidFrom the article:

    PrEP critics fear that a reduction in condom use could lead to a rise in other sexually transmitted diseases (STDs).

    "We are seeing a high numbers of STDs in people on PrEP," Hare acknowledged, but again he stressed that there is no control group of people not taking PrEP to use for comparison.

    These STDs include the "usual suspects" syphilis, gonorrhea, and chlamydia, he said, but Kaiser providers have also seen two cases of acute hepatitis C in HIV-negative gay men who were not injection drug users. Sexually transmitted hepatitis C has been reported among HIV-positive men over the past decade and a half, but it has been thought to be rare among HIV-negative men.


    PrEP does have the potential to tip HIV below epidemic levels, which would be wonderful, but gay men and the AIDS industry have to stop acting like HIV is the only STD that matters. We're in the last few days of the era of cheap, easily treated STDs. We've burned through nearly every antibiotic that once worked, and no new ones are on the horizon, because HIV is where the money is.

    This is where PrEP cheerleaders will jump in and say, "but most of those STDs are easily spread by oral sex," to which my response is: Yeah. Exactly. Maybe it's time to reevaluate your definitions of "safe sex" and your expectations about what should happen on a hookup to account for that fact instead of rationalizing barebacking on PrEP.



    They are spending money on new antibiotics:
    [b]
    Breakingviews: Merck bets $8.4 bln on more profitable antibiotics


    http://www.reuters.com/article/2014/12/08/cubist-pharm-ma-merck-co-breakingviews-idUSL1N0TS1VZ20141208


    Syphilis Treatment and Prevention
    [/b]
    "When syphilis is diagnosed early, it's easy to treat with antibiotics — usually penicillin. "The best treatment for syphilis is still penicillin," says Shuford, and how long the treatment will last depends on how long you've had the infection. Non-penicillin antibiotic alternatives are available for people who are allergic to penicillin."

    [url]http://www.everydayhealth.com/sexual-health/syphilis.aspx
    [/url]

    The PROBLEM is gonorrhea!


    The rise of antibiotic-resistant bacteria
    http://www.smasa.cc/the-rise-of-antibiotic-resistant-bacteria/

    Renewed vigor for antimicrobial stewardship

    One positive outcome of the emergence of cefixime resistance was a renewed approach to antimicrobial stewardship. Across the globe, treatment guidelines were rapidly revised before widespread treatment failure emerged and, for the first time, recommended dual therapy, typically 250 mg to 500 mg of ceftriaxone (administered parenterally) and an oral dose of 1 g to 2 g azithromycin. In theory, this more aggressive regimen should slow the development of resistance, as the likelihood of a strain simultaneously acquiring resistance mechanisms to both antimicrobials is lower. Whether this is too little, too late remains to be seen, but early data are encouraging.

    There is no room for complacency, however, as the potential for current therapies to be compromised by resistance remains. The most imminent threat to dual therapy is high-level azithromycin resistance (AziHR). Azithromycin is rarely used alone to treat gonorrhea, but MICs at this level (≥128 mg/L) almost certainly would result in treatment failure. To date, AziHR occurs sporadically, and has not been documented in combination with raised ceftriaxone MICs. However, some gonococcal strains sensitive to azithromycin can quickly recombine under selection pressure in vitro to develop high-level resistance. Although dual therapy to treat gonorrhea is unlikely to create that selection pressure, there are other clinical situations that could (eg, use of 1 g azithromycin to treat non-gonococcal urethritis before culture or GC-NAAT results are available). Additionally, ceftriaxone MICs as high as 2 mg/L and pharyngeal treatment failures with ceftriaxone monotherapy are documented. Fortunately, acquisition of extended-spectrum beta-lactamases is not.

    [url]http://www.healio.com/infectious-disease/news/print/infectious-disease-news/%7B594fc367-6950-44d7-ad60-e973c4448cac%7D/managing-the-threat-of-untreatable-gonorrhea[/url]

    So everyone is dying from "Untreatable Gonorrhea", Right?

    Not quite

    Conclusions


    N. gonorrhoeae isolates in Nanjing generally retained similar antimicrobial resistance patterns to isolates obtained five years ago. Fluctuations in resistance plasmid profiles imply that genetic exchange among gonococcal strains is ongoing and is frequent. Ceftriaxone and spectinomycin remain treatments of choice of gonorrhea in Nanjing, however, decreased susceptibility to ceftriaxone and rising MICs for spectinomycin of N. gonorrhoeae isolates underscore the importance of maintaining surveillance for AMR (both phenotypic and genotypic).

    http://www.biomedcentral.com/1471-2334/14/622/

    Certainly the CDC's Untreatable: Today’s Drug-Resistant Health Threatsis worth reading.

    http://www.cdc.gov/media/dpk/2013/dpk-untreatable.html