The sixth known case of seroconversion while taking pre-exposure prophylaxis (PrEP) was reported at IDWeek 2018 in San Francisco, though PrEP researcherMonica Gandhi of UCSF assured aidsmap that there should be little reason for concern: “I really want to say that PrEP is almost there in terms of 100% [protection].This is a rare case and I don’t want anyone to worry too much. It’s 99%, and that’s pretty good for a medical intervention.”
aidsmap reports: “The new case involves a 21 year-old Latino man who reported having sex with men, transgender women and cisgender (non-trans) women. He started taking daily PrEP at San Francisco’s main sexually transmitted infection clinic. At that time he tested negative for HIV antibodies and HIV RNA. The man was prescribed a 30-day supply of Truvada with two refills and asked to return in three months for follow-up monitoring. He again tested HIV-negative at three, six and 10 months after PrEP initiation. At his 13-month visit, the man said he had recently used methamphetamine and had condomless receptive anal sex, but he reported excellent PrEP adherence. A rapid HIV antibody test was negative and his PrEP prescription was renewed. But five days later his HIV RNA test came back positive, with a viral load of 559 copies/ml.”
aidsmap adds: “Genotypic and phenotypic testing showed that the man’s HIV was resistant to emtricitabine but remained susceptible to tenofovir. His virus carried the L74V, L100I, M184V and K103N mutations, but not the K65R tenofovir-resistance mutation. Further, the genetic diversity of his virus population suggested he had acute infection, probably acquired within the previous few weeks. In addition, one of the man’s sexual partners was found to be HIV-positive with the same viral genotype and an HIV RNA level of 15,000 copies/ml, and he was re-linked to care. The fact that the partner’s virus had the same resistance pattern suggests transmission of resistant virus, rather than resistance newly emerging in the recently infected man.”
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A recent study offered some revealing numbers on PrEP usage: ‘In the U.S., nearly one in six study participants and nearly one in four men who have sex with men who were eligible for the pill, called Truvada, were using it by 2016, the study found. “Self-reported PrEP use among these men is approximately doubling each year,” said lead study author Emiko Kamitani of the U.S. Centers for Disease Control and Prevention in Atlanta…In the U.S. alone, an estimated 1.2 million people should be on PrEP, the study authors note. Only about 120,000 people have filled prescriptions at retail pharmacies between 2012 and early 2017, which suggests many who need treatment aren’t getting it.’