THE FIGHT SOCAL'S LGBTQ MONTHLY MAGAZINE MARCH 2016

A PreP-adherent gay male tested positive
for HIV after being exposed to an
extremely rare strain of that virus.
BY BRENDEN SHUCART
HIV
activists, advocates, and healthcare professionals
gathered in Boston last month for the
annual CROI (Conference on Retroviruses and
Opportunistic Infections ) where they received some unwelcome
news—the first documented case of a fully adherent PrEP recipient
testing positive for HIV.
Researchers out of Canada presented evidence that a PrePadherent,
42-year-old, gay Toronto resident tested positive for HIV
after being exposed to an extremely rare strain of that virus which
had developed resistance to emtricitabine and tenofovir—the two
drugs which make up Truvada, currently the only drug approved by
the FDA for use as a Pre-Exposure Prophylaxis against HIV.
PRACTICALLY INEVITABLE
This unfortunate development has—understandably—sent tremors
of concern radiating out through the HIV prevention community,
but statistically speaking such an event was practically inevitable.
Since it’s approval by the FDA in 2012, Truvada-as-PrEP has proven
to be remarkably effective at preventing HIV infection. But the “nearly
perfect” protection against HIV provided by Truvada—often quantified
as “more than 99% effective—still isn’t completely perfect.
Thankfully, the emtricitabine/tenofovir resistant strain is
exceedingly rare—it’s carried by fewer than 1% of those living
with HIV—and even if an individual does carry this rare strain, it
would be almost impossible for them to pass it along if they are
on treatment, and undetectable.
NEW FORMS OF PrEP
There are also new forms of PrEP in the pipeline, drugs like
maraviroc (a combination of Celsentri & Selzentry) which may
prove effective at protecting against this strain in the future.
Truvada-as-PrEP is still the most effective tool in the fight to
end the HIV epidemic—a fact underscored by this being the first
documented case of infection among the estimated 40,000 PrEP
users over the last 4 years.
The example of this “Toronto Patient” provides a sobering reminder
that there are no “silver bullets” in HIV prevention. There
are only tools and strategies to help us manage risk—not one of
which can end the epidemic on it’s own.
MARCH 2016 | THE FIGHT 25