One year a #TruvadaWhore, and…

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It’s actually over one year – more like a year and four or five months since I started on Truvada.

I don’t really want to write about me today, what I want to write about is two things:

– Health Canada has officially endorsed Truvada for PrEP – This is huge as it allows provinces to possibly start coverage as part of drug programs, as well insurance companies will start covering Truvada for PrEP.  Some insurance companies already do, although some have been known to stop if they realize it’s not for someone living with HIV.
– We have our first report of someone seroconvert to HIV while taking PrEP properly.  Even more interesting is that the paper was presented by my own GP this week at CROI (Conference on Retroviruses and Opportunistic Infections).  
Not much to write about with Health Canada other than I will probably switch from Toronto General to having my PrEP handled by my actual GP.

Someone seroconverting while taking PrEP properly was always a “when” not an “if” for me.  The case of someone seroconverting while taking PrEP properly that was reported this week at CROI (Conference on Retroviruses and Opportunistic Infections), by my actual GP, Dr. David Knox. (Link is to the actual presentation which has a lot of great information.)

Previous research showed that the only people who seroconverted were those who were not taking the medication properly.  That would imply 100% effectiveness, but not quite.  We know that it’s possible for resistant genotypes of HIV to be transmitted to someone who is already positive, causing drug resistance.  We also didn’t know (and somewhat still don’t know) the percent effectiveness between someone who is positive and detectable versus positive and undetectable fucking a negative guy on PrEP.

What’s clear is

  • If someone is positive and undetectable they cannot transmit HIV to someone.
  • If someone is positive and not undetectable and not resistant to the medications in Truvada as PrEP, they’re unlikely to transmit HIV to someone but there is some risk.
  • If someone is positive and not undetectable and resistant to the medications in Truvada as PrEP, it is very possible that they will transmit HIV to someone, it’s risky.

Some details from the presentation:

  • The 43 year old was bottoming and was definitely neg prior to going on PrEP, had been on PrEP for 2 years, and has been shown to be taking his PrEP properly.
  • The top was poz and had a genotype of HIV that was drug resistant to both components of Truvada.
– It is suggested that the top was not undetectable.  The researchers say this because it has been shown in recent research that someone who is undetectable cannot actually transmit HIV to someone who is neg, even if they have the genotype of virus that is resistant to Truvada.

That said, researchers are implying that the type of resistance to the active medical components of Truvada seen in this case is rare.

Still, this goes to show that no medication is a silver bullet, and anyone I’ve talked to has always said that.

1 in 40,000 – That’s 0.000025%.  5 years of people fucking while on PrEP – some using condoms, some not. That said, think of all those loads taken and given.  That’s a lot of ejaculate!  Not to make light of the situation, but seriously, the point is PrEP is still a highly effective means of prophylaxis against HIV.  The odds are very good right now.  Still, be aware of what’s going on and keep yourself up-to-date with info, what’s happening out there with drug resistance.

The upshot:
  •  PrEP is still very effective.  They are still saying it is 99.8% effective against HIV.
  • Anyone in the medical community looking at PrEP is saying, if you’re active get on it.
  • This is a rare exception.  5 years of research and countless number of loads taken and given, where no one taking the medication seroconverted in many respects proves that PrEP is very effective.  There were people who did seroconvert, but it was shown that they were not taking their medication properly.
  • There are currently around 44,000 people prescribed Truvada; this is one person of 44,000. Statistically, that is around 0.00002% which is of no statistical value, ask any statistician.
  • The CDC (Center for Disease Control) still considers PrEP to be more effective than condom use.  Here is a great visual tool: https://wwwn.cdc.gov/hivrisk/index.html – I still maintain that if anyone is fucking around casually and using just condoms, get on PrEP too.