Gay Man Becomes First Reported Daily PrEP User to Contract HIV

  • metta

    Posts: 39165

    Feb 25, 2016 9:10 PM GMT
    Gay Man Becomes First Reported Daily PrEP User to Contract HIV

    "the strain of HIV which he came into contact with was resistant to tenofovir and emtricitabine, the two main drugs in Truvada."


    http://www.towleroad.com/2016/02/prep-hiv-2/
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    Feb 26, 2016 12:07 AM GMT
    Hopefully that rare strain stays that way ... rare.
  • interesting

    Posts: 584

    Feb 26, 2016 7:39 AM GMT
    I saw that article, briefly read through it and I have to read a more detailed article to see. I didn't think anything could have evaded the combination and infect.
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    Feb 26, 2016 4:23 PM GMT
    Oops!
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    Feb 26, 2016 4:39 PM GMT
    CODY4U saidOops!

    What does that do to the "you can bareback using PrEP" advocates?
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    Feb 26, 2016 4:48 PM GMT
    While it is bad news, it's not terrible news "After mutations were detected, the patient’s antiretroviral medications were adjusted, and the patient’s viral load now remains undetectable to date."

    "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.

    So its presence also supports the conclusion that this is a case of transmitted resistance. Overall, our patient’s profile suggests that he was exposed to somebody who was failing a regimen of TDF/FTC/elvitegravir/cobicistat, or Stribild,” said Knox.

    http://betablog.org/dr-robert-grant-weighs-in-after-the-first-case-of-failed-prep-what-does-it-mean/
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    Feb 26, 2016 4:54 PM GMT
    Art_Deco said
    CODY4U saidOops!

    What does that do to the "you can bareback using PrEP" advocates?


    I see dumb and dumber are at it again.

    Read the above post.
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    Feb 26, 2016 5:12 PM GMT
    i believe just like how a condom is not 100% safe
    its the same for prep, it reduces the chance significantly, but not 100%
    everybody is responsible for their own health,
    prep is not a free card for bare sex, but is sure helps cut down the chance of getting
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    Feb 26, 2016 5:37 PM GMT
    And condoms STILL are not better at protecting against HIV than PrEP.
    Anal sex with condoms has not been studied well. (And condoms are not approved by the FDA for anal sex.)

    "If used perfectly, male/external condoms can be up to 98% effective at preventing pregnancy. In reality they are only 85% effective – an average of 15 women out of 100 get pregnant when using condoms as their only form of protection for a year."

    Birth Control Pill, Patch, Ring or Shot
    : Because the pill, patch, and ring have room for human error, eight women out of 100 will get pregnant while using them for a year. Using these methods with condoms makes them extremely effective at preventing pregnancy. Condoms will also reduce the small risk of pregnancy with the Depo Shot.
    IUDS: IUDs are small devices a doctor implants into the uterus, and are extremely effective methods of birth control (over 99% in actual use). Condoms used with an IUD lower risk of a rare pregnancy. Copper IUDs are also the most effective emergency birth control. See the section on “If a condom breaks or slips off” for more information.

    http://everywomanshealthcentre.ca/condoms/

    PrEP is better than the 8% for "the pill". For that 1% you can use a condom too. We all take risks. This is about risk reduction.

    This guy did everything right, he took his PrEP religiously. But his partner was failing his ART regime. (Probably from not taking his meds) So he wasn't undetectable. Even worse he brought along his resistance to Stribild. He needed to change his ART meds to become undetectable again.

    It's very important for people on ART to take their meds as prescribed with at least 90% compliance. If they don't and become detectable there is a potential risk to people on PrEP with the same drug ingredient or family of that drug, rendering that component useless. The formula can be changed if resistance is detected.

    It is still an isolated case. The guy on PrEP is successfully undetectable already. So we know it didn't wipe out other classes/families of drugs to use.
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    Feb 26, 2016 5:37 PM GMT
    timmm55 saidWhile it is bad news, it's not terrible news "After mutations were detected, the patient’s antiretroviral medications were adjusted, and the patient’s viral load now remains undetectable to date."

    "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.

    So its presence also supports the conclusion that this is a case of transmitted resistance. Overall, our patient’s profile suggests that he was exposed to somebody who was failing a regimen of TDF/FTC/elvitegravir/cobicistat, or Stribild,” said Knox.

    http://betablog.org/dr-robert-grant-weighs-in-after-the-first-case-of-failed-prep-what-does-it-mean/


    There is no half full/half empty with this scenario, Timmy. This person is 100% fucked now (for life) because he bought the hype about the magic pill that allows gays to bareback "safely". This is exactly what was predicted back when you guys had all your numbers and studies that supposedly proved this would not happen...and now it has happened.
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    Feb 26, 2016 5:42 PM GMT
    Art_Deco said
    CODY4U saidOops!

    What does that do to the "you can bareback using PrEP" advocates?


    Apparently it means they'll start backpedaling with a bunch of half empty/half full BS. icon_lol.gif
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    Feb 26, 2016 5:49 PM GMT
    CODY4U said
    timmm55 saidWhile it is bad news, it's not terrible news "After mutations were detected, the patient’s antiretroviral medications were adjusted, and the patient’s viral load now remains undetectable to date."

    "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.

    So its presence also supports the conclusion that this is a case of transmitted resistance. Overall, our patient’s profile suggests that he was exposed to somebody who was failing a regimen of TDF/FTC/elvitegravir/cobicistat, or Stribild,” said Knox.

    http://betablog.org/dr-robert-grant-weighs-in-after-the-first-case-of-failed-prep-what-does-it-mean/


    There is no half full/half empty with this scenario, Timmy. This person is 100% fucked now (for life) because he bought the hype about the magic pill that allows gays to bareback "safely". This is exactly what was predicted back when you guys had all your numbers and studies that supposedly proved this would not happen...and now it has happened.


    Bull. So what about the guys who became POZ while using condoms?

    He's now undetectable. He'll live a healthy normal life span. That's hardly "100% fucked".
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    Feb 26, 2016 5:51 PM GMT
    CODY4U said
    Art_Deco said
    CODY4U saidOops!

    What does that do to the "you can bareback using PrEP" advocates?


    Apparently it means they'll start backpedaling with a bunch of half empty/half full BS. icon_lol.gif


    That quote was from Robert Grant, MD, MPH, I don't think he's a BB advocate. And it was 99% full, 1% empty.

    You are the bull shiiter claiming now it suddenly 50%. Really DUMB!
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    Feb 26, 2016 6:08 PM GMT
    timmm55 said
    CODY4U said
    Art_Deco said
    CODY4U saidOops!

    What does that do to the "you can bareback using PrEP" advocates?


    Apparently it means they'll start backpedaling with a bunch of half empty/half full BS. icon_lol.gif


    That quote was from Robert Grant, MD, MPH, I don't think he's a BB advocate. And it was 99% full, 1% empty.

    You are the bull shiiter claiming now it suddenly 50%. Really DUMB!


    I was clearly referring to the saying and not the direct quote (that plays on the saying). If I promise your brain won't explode if you try to comprehend before replying, will you try it just once?
  • Sincityfan

    Posts: 409

    Feb 26, 2016 8:29 PM GMT
    S34n05 saidHopefully that rare strain stays that way ... rare.


    Depends on how hot he is.
    If you want to continue barebacking you can either:
    A: Go on a crusade
    B: Ignore it
    C: Ignore it
    D: Ignore it
    E: Option B-D

    People are going to continue barebacking regardless- most people prefer it- "it feels better"
    Don't you agree? icon_wink.gif
  • Eli_jah

    Posts: 1391

    Feb 26, 2016 10:46 PM GMT
    Uh...

    Poz.comThe man in the case study reported multiple acts of receptive anal intercourse without a condoms during the two-to-six week period before testing postivie for HIV. He has no reported history of injection drug use.


    https://www.poz.com/article/prep-fails-gay-man-adhering-daily-truvada-contracts-drugresistant-hiv
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    Feb 27, 2016 4:48 AM GMT
    CODY4U said
    Art_Deco said
    CODY4U saidOops!

    What does that do to the "you can bareback using PrEP" advocates?

    Apparently it means they'll start backpedaling with a bunch of half empty/half full BS. icon_lol.gif

    And so it seems they are already. But the promises and advice given here about PrEP proved false.

    If any RJ members subsequently contract HIV using PrEP alone and barebacking, I wonder if they would have a case to sue these barebacking RJ advocates who misled them? A thought to consider when giving any definitive medical advice online.
  • Sincityfan

    Posts: 409

    Feb 27, 2016 6:03 PM GMT
    Art_Deco said
    CODY4U said
    Art_Deco said
    CODY4U saidOops!

    What does that do to the "you can bareback using PrEP" advocates?

    Apparently it means they'll start backpedaling with a bunch of half empty/half full BS. icon_lol.gif

    And so it seems they are already. But the promises and advice given here about PrEP proved false.

    If any RJ members subsequently contract HIV using PrEP alone and barebacking, I wonder if they would have a case to sue these barebacking RJ advocates who misled them? A thought to consider when giving any definitive medical advice online.


    no.
  • metta

    Posts: 39165

    Feb 27, 2016 6:08 PM GMT
    The following opinion is not mine but may be of interest to some and may make some angry. Either way, I don't think that we should be afraid to talk about it:



    Op-Ed: It's Not Irresponsible to Like Bareback Sex

    http://www.hivplusmag.com/prevention/2016/2/27/op-ed-bareback-sex-not-stupid-immoral-or-irresponsible
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    Feb 27, 2016 6:12 PM GMT
    thorn27 saidi believe just like how a condom is not 100% safe
    its the same for prep, it reduces the chance significantly, but not 100%
    everybody is responsible for their own health,
    prep is not a free card for bare sex, but is sure helps cut down the chance of getting


    Absolutely agreed. That's why I'll write in my profile text, "Please understand that I will always use condoms during sex, even if you are taking PrEP medication".

    I'm not interested in stigmatizing HIV positive people nor am I interested slut shaming people who enjoy barebacking.

    People are allowed to make conscious and informed decisions to use PrEP and take certain risks, and that's okay. We all make concessions and compromises. For example, how many of us dental dams?

    I've made a conscious and informed decision to always use condoms. I understand that all of these methods of prevention are nearly but not exactly 100% effective. However, they are all important tools in minimizing the spread of HIV and other STDs.

    Hopefully, the guys who like me will respect my decisions as I respect theirs and then figure it out together.
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    Feb 28, 2016 3:09 AM GMT
    First: I hope hellfire rains upon those who do not take their medication as prescribed by their doctor. They not only endanger themselves, they endanger everyone by creating precisely the kind of superbug nobody can do anything about. Either do not take the medication at all or take it as directed. Die or live, but do not contribute to everyone else's demise.

    Second: I have heard several of my friends on PrEP complaining about feeling or being pressured to bareback. My advice to all of them is: get on PrEP if you can, and never tell anyone that you are. Never ever wave it around as a magic wand to tell people you are "safe". It's a tool for your own protection, end of story.

    Third: We had a chance to eradicate this virus from the community. We didn't pursue this aggressively, and plenty of us were against it because of some misguided moral idea that PrEP would make people bareback more. Medicine trumps morality, as we knew back in 1985. Back then it was about bathhouse closures, now it's about PrEP.
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    Feb 28, 2016 4:27 PM GMT
    MuchMoreThanMuscle said
    CODY4U said
    Art_Deco said
    CODY4U saidOops!

    What does that do to the "you can bareback using PrEP" advocates?


    Apparently it means they'll start backpedaling with a bunch of half empty/half full BS. icon_lol.gif


    Actually, from a medical standpoint one documented failure of a medication after monitoring thousands of participants over several years is still pretty incredible. In fact, it's outstanding.

    I never expected prEP to be 100% foolproof. But it's doing a lot better than I had anticipated. When medical breakthroughs make their way to the public there is almost never a such thing as 100% success rate. But if America can reduce its annual HIV infection rate from 45-50K annually to a mere fraction then we've created huge success. That's a realistic goal. If, say, only ten people get HIV as opposed to 50K that's significant progress.

    My only concern is that this person has a multiple drug resistant strain of HIV (in addition to the person who gave it to him in the first place). I hope these people are able to control their more resistant strain of HIV and not spread it to others to the point of creating a much bigger problem.


    Mmmhmm. It's one now. Let's wait and see how many more pop up before we rush to call this a fluke. Let's also wait until these drug companies know what long-term use does to the body before we call it a success. I think it's actually a good thing that this person was infected because it's a reality check, or at least it should be. This is a reminder that PrEP doesn't make one invincible.
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    Feb 28, 2016 9:04 PM GMT
    Art_Deco said
    CODY4U said
    Art_Deco said
    CODY4U saidOops!

    What does that do to the "you can bareback using PrEP" advocates?

    Apparently it means they'll start backpedaling with a bunch of half empty/half full BS. icon_lol.gif

    And so it seems they are already. But the promises and advice given here about PrEP proved false.

    If any RJ members subsequently contract HIV using PrEP alone and barebacking, I wonder if they would have a case to sue these barebacking RJ advocates who misled them? A thought to consider when giving any definitive medical advice online.


    Should we also sue the condom makers? Condom efficacy is 70% for anal sex, and 80% for vaginal sex.

    http://www.aidsmap.com/Consistent-condom-use-in-anal-sex-stops-70-of-HIV-infections-study-finds-but-intermittent-use-has-no-effect/page/2586976/

    Or sue your sorry ass for advocating an inferior product?

    If 1 of the 657 of the Kaiser Permanente PrEP users had become POZ it would be a .0015 chance. But that didn't happen in this study that was over 2 years. It's important to remember that tests need to be done for everyone: PrEP, ART and (more importantly) people who are not on any HIV medications.

    That study also shows that resistance is rare.

    IF 2 people were 'cured' of HIV, do we say AIDS is over? Of course not. If 4 people got HIV while using condoms does that mean condoms are worthless? NO.

    Art Deco always makes it an us vs them scenario. Stupid. But if he wants to pursue that mentality he is Miami-Ft Lauderdale (where he says he gets his information from, all locally) I am more San Francisco. Miami is increasing in new HIV infections by 28% last year, SF is decreasing yearly by 18%, now down to 302 from a high of 2300 a year.

    Quite frankly Miami/Ft Lauderdale AIDS policy is a mess, as is most of the south.

    San Francisco, NYC and DC have made great strides and improvements. All 3 encourage PrEP use....go figure.
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    Feb 28, 2016 9:11 PM GMT
    CODY4U said
    timmm55 said
    CODY4U said
    Art_Deco said
    CODY4U saidOops!

    What does that do to the "you can bareback using PrEP" advocates?


    Apparently it means they'll start backpedaling with a bunch of half empty/half full BS. icon_lol.gif


    That quote was from Robert Grant, MD, MPH, I don't think he's a BB advocate. And it was 99% full, 1% empty.

    You are the bull shiiter claiming now it suddenly 50%. Really DUMB!


    I was clearly referring to the saying and not the direct quote (that plays on the saying). If I promise your brain won't explode if you try to comprehend before replying, will you try it just once?


    Yes I understood the saying, and so did the Doctor. That's why he said 99% full, 1% empty.

    The innuendo of 50:50 was already referring to and debunked. What I get from your comment is you are trying to make it 50:50 when it clearly is not.

    Maybe your pea soup for brains doesn't get that any reference to "full/empty" already implies the cliche of half and half.

    When you say dumb shit like: "Apparently it means they'll start backpedaling with a bunch of half empty/half full BS." There is no reason to backpedal for a case of 1. Nor is it half and half.....that's your ignorant take on your poor reading skills.
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    Feb 28, 2016 9:15 PM GMT
    Question

    dr. Joel, There is going to be so much talk about this unlucky person who failed on PrEP. I read the report from CROI on web and all the mutations he got, I
    would say PrEP would fail in future only because of wreckless hiv+ patients who don't respectthe given ART. Going on brakes from meds is most likely the cause of such things. I'm UD and I would 'need' to stop taking if I wanted to 'pass' such a virus. I fell very sad that (gay) hiv+ community hasen't learned the lesson of past three decades.


    Answer

    Just as we shouldn’t cast stones at people who choose PrEP over condoms, as many of the “slut-shamers” have done, we also shouldn’t make judgments about people who stop their meds and still have sex, as tempting as that might be.

    We don’t know all the details of this case, but it points to the fact that PrEP will never be 100% perfect. A scenario that’s not uncommon in my experience is that someone who is virologically suppressed on ART develops a crystal meth habit and then begins to take HIV meds erratically or not at all. The viral load increases, and they begin transmitting HIV, sometimes with resistance. If you rely on PrEP as your only form of prevention, you can’t protect yourself against someone like that. Fortunately, what happened in this case is extremely rare, and will probably remain rare.


    http://hivforum.tumblr.com/