On the 22nd of March, the Sydney Morning Herald reported that a gay man has contracted HIV while using #PrEP. The major difference in this man’s case is that he was using, so called, PrEP on demand. On-demand dosing involves taking a double dose of PrEP (two pills) from 2-24 hours before anticipated sex, and then, if sex happens, additional pills 24 hours and 48 hours after the double dose. In the event of sex on several days in a row, one pill should be taken each day until 48 hours after the last sexual intercourse. This method has been proven to be just as effective as traditional dosing.

So, what’s the problem?  As the article states, “Steven Spencer, 27, tested positive for HIV in December, despite diligently using PrEP “on demand” before and after sexual encounters in line with the advice of doctors.” Mr. Spencer just happened to be one of the very unlucky individuals who fell within the 1%. PrEP is still 99% effective in preventing the infection of HIV in gay males. Andrew Grulich, program head of HIV Epidemiology and Prevention at the University of NSW’s Kirby Institute, said PrEP had been a “game-changer for HIV prevention in Australia and that most of the HIV seroconversion cases identified had involved a virus that is resistant to the anti-viral medication contained in PrEP.

“PrEP only works if it is taken correctly, so non-adherence is certainly a factor in some cases,” he said. Professor Grulich said the extremely rare cases did not contradict the global scientific consensus that PrEP was an extremely effective HIV prevention tool. “Individuals should remain confident of PrEP’s effectiveness,” he said.

As for Mr. Spencer, he is doing very well on his HIV medication regime and is now undectable, so he cannot transmit the virus to others.   

The exception:

 Daily, around the world tens of thousands of people successfully take PrEP without issue or failure. This is a fact. But, as reported by Poz.com (NEVER, EVER READ THEIR UNMODERATED COMMENTS PAGE!), a Dutch man who was the third person in the world to fail on a PrEP regime, was not due to drug resistance. His case has puzzled experts because the only two cases of PrEP failure documented at the time, all involved rare drug-resistant strains of the virus that apparently evaded the two drugs in Truvada. Researchers are able only to speculate as to how this man could have contracted HIV. They theorize that his “remarkably high” number of sex partners and condomless sex episodes may have contributed to this aberrant outcome. 

Seeking to assuage anxieties that may arise from the news of this case, Hoornenborg, told POZ at CROI, “Internationally, tens of thousands of people are using PrEP. And we see that PrEP offers a high degree of protection against HIV. It’s not 100 percent. So we’ll have to acknowledge that. It also doesn’t protect against STDs. So we think it’s clever to combine different prevention methods—PrEP being one of them, condoms and other risk-reducing behaviors being other ones.” Researchers estimate that PrEP reduces the risk of HIV by 99 percent when taken daily as prescribed. In fact, due to a high level of “dosing forgiveness,” taking just four tablets per week still likely confers maximum protection (although taking PrEP that infrequently is not recommended). Now, if you are like most gay males, you or someone you know has claimed that failure on PrEP is very common and that it has happened to you/him or many guys that you/he knows. The protocol for taking PrEP is well established.

  1. HIV testing BEFORE starting a PrEP regime (If Positive for HIV, guy is started on HIV treatment immediately)
  2. Tested for HIV and other STIs every 3 months
  3. Tested for the amount of PrEP in blood to ensure taking as directed
  4. General check-up during this time period
  5. A test for medication resistance
  6. If…if someone seroconverts to HIV+ while on PrEP, they are reported to the managing government health agency for logging and further study
  7. If this person actually contracted HIV, research will begin to see how he contracted it and why
  8. Now this HIV+ person will be treated for HIV successfully until he becomes undetectable and uninfectious
  9. Finally, this person will be added to the three above and the findings presented at the World AIDS conference and other HIV research bodies of experts.

If you are claiming that you or someone you know failed on PrEP but this protocol was not performed we highly recommend that you stop posting anonymously on Comments Sections, take all of your medical records, doctor’s information and contact your local board of health/CDC as well as the media immediately, and get your story told. It is important that we know the real number of people that are failing on this medication. You can help shed light on this conspiracy. /s

Tags: , , , ,