But such cases of failure to PrEP should be very unusual
A New York City physician documented a case in which a male patient taking Truvada (tenofovir / emtricitabine) as a pre-exposure prophylaxis contracted a rare and highly resistant strain of antiretroviral drugs, although he maintained PrEP responsibly, exactly as had been prescribed. This is the second documented case of PrEP failure of men who have sex with men (MSM), following the report February during the Conference on 2016 retroviruses and opportunistic infections (ends) in Boston regarding a Toronto MSM although under PrEP it contracted HIV under similar circumstances.
Considering how popular PrEP became in the United States in particular, the fact that there were only two documented cases of recorded PrEP failure underscores the strong likelihood that such cases will remain very rare. From the end of 2015, maybe more than 80,000 resistant people in the US had requested at least one PrEP prescription. Judging by the rapid increase in the rate of quarterly prescriptions in the United States, the number of people taking PrEP is now considerably higher.
In both documented cases of PrEP failure, clinicians caring for these men were proactive and smart enough to initiate the necessary tests in order to find scientific evidence that these men say they were adhering well to the Truvada regimen daily. Both contracted HIV not because they did not take PrEP as prescribed, but because the HIV strains they contracted were resistant to both drugs from each antiretroviral therapy (ART found in Truvada.
Given the rarity of transmission of multidrug-resistant strains, it is unlikely that there were many other examples declared failure of PrEP.
Howard A. Grossman, MD, who until recently was a doctor in New York City specializing in primary care services for men who have sex with men (MSM), reported the new case in HIV research for the prevention (HIVR4P ) in Chicago. Grossman, who had a large number of patients using PrEP in New York and now practices medicine at the Cleveland Clinic in West Palm Beach, Florida, said the patient who contracted HIV during PrEP is a man who has sex with men (MSM) in their twenties who are in a relationship with an HIV-positive man. Your partner has kept fully suppressed viral load thanks to antiretroviral treatment (ART).
A considerable amount of research that has led scientists to estimate that HIV-positive individuals who have a fully suppressed virus, also known as having an undetectable viral load, are virtually non-infectious. (Note: Even with undetectable viral load he transmitted HIV would siado on one viral blip.Client Build #3
Covered by the standard PrEP protocol, individuals are supposedly tested for HIV every three months for the purpose of receiving a new prescription of Truvada. Grossman claims that the man could not make his quarterly appointment, which should have taken place around April 1, but he gave him a new recipe for Truvada anyway until he could make it to test. The man said that before positive test he had unprotected sex with your partner several times, practicing both insertive (top) and receptive role (below). He also said that he had been the insertive partner with two male partners during two separate incidents that occurred five weeks and a half and eleven weeks before the positive test for HIVrespectively. He did not use condoms for any sexual encounter.
The man said he had fulfilled perfectly the scheme Truvada daily. Grossman asked a dry blood test on site and the analysis of a man's hair sample. The results of each test were consistent with excellent adhesion to PrEP in the previous thirty and sixty days.
Such tests are time-sensitive. The dried blood spot test can only measure adherence dating back to one or two months. Hair tests and are limited by the individual's hair length. So time is essential for doctors to carry out such tests to determine adherence to Truvada after someone receiving PrEP test positive for HIV.
human genotyping tests found virus strains that had several resistance mutations, including those that confer resistance to each of the two drug Truvada, tenofovir and emtricitabine. The transmission of such multidrug resistant strains are rare, regardless of whether someone is taking Truvada, suggesting that such cases of PrEP failure remain quite unusual. In other words, there are very good reasons to believe that the researchers were correct when it is estimated that PrEP is over 99% effective in preventing HIV when taken daily.
The fact that the man had "apparently" contracted HIV sex he was the insertive partner adds to rarity of your case. Men are much less likely to contract the virus in the receptive sex than of the receptive sex (Granted, that self sex on reports can not be trusted, so that the man may have actually contracted the virus through receptive sex).
Grossman kept the man in Truvada while performing the first round of tests to confirm that it was indeed HIV positive. Then, in 26 May he prescribed his Tivicay patient (dolutegravir) plus Truvada to build a full course of treatment of HIV (three or more ARVs are needed to treat the virus; Truvada contains only two). After you see the drug resistance report, Grossman prescribed also the Prezcobix (darunavir / cobicistat) to step up its scheme.
The man is good adherence to HIV treatment and maintaining an undetectable viral load.
Grossman points out the POZ “important points”, including “PrEP works and is the most successful intervention we've had; failures were infinitely rare (tell that to the victim of the failure) and that nothing changes; and can get infected. ” He added that condoms can further reduce the risk of HIV infection.
Translated by Claudio de Souza the original Second Man Contracts Rare HIV Strain While Adhering to PrEP by By Benjamin Ryan 19 October 2016 oara to POZ.
Revised Mara Macedo