Nigel Campbell's picture

2.5 Years Later, Zero Cases Of HIV In Large San Francisco PrEP Group

A new study reveals that after 2.5 years, a group of more than 600 San Francisco men who have sex with men (MSM) taking Truvada as pre-exposure prophylaxis (PrEP) have had zero cases of HIV contraction.  

The study also finds that many of these individuals are using condoms less and more than half of those in the group study had contracted at least one sexually transmitted infection (STI) within a year. 

From POZ.com:

Researchers at Kaiser Permanente published their findings in Clinical Infectious Diseases. The paper represents a powerful endorsement of PrEP’s ability, in a real-world setting, to prevent HIV infection among those at very high risk of contracting the virus. The lack of new HIV infections among these men challenges the stance of AIDS Healthcare Foundation president Michael Weinstein, who has vigorously campaigned that PrEPshould not be used as a widescale public health intervention.

On the flip side, the Kaiser findings challenge the received wisdom from PrEP clinical trials that those taking Truvada as HIV prevention do not increase sexual risk-taking while on the medication.

“Our study is the first to extend the understanding of the use of PrEP in a real-world setting and suggests that the treatment may prevent new HIV infections even in a high-risk setting,” reports lead author Jonathan Volk, MD, MPH, a physician and epidemiologist at Kaiser Permanente San Francisco Medical Center. “Until now, evidence supporting the efficacy of PrEP to prevent HIV infection had come from clinical trials and a demonstration project.” 

It's important to reiterate that according to Kaiser, though no one using PrEP contracted HIV, there was a very high rate of other sexually transmitted infections (STIs).

POZ.com breaks it down:

After six months, the clinicians at Kaiser surveyed 143 of the cohort about their sexual risk-taking. At that time, 74 percent reported that their number of recent sexual partners had not changed since starting PrEP, while 15 percent said they had fewer sexual partners and 11 percent said they had more. Regarding condom use, 56 percent said they used them at the same rate after starting Truvada, 41 percent used them less and 3 percent used them more. 

Because these individuals were not engaged in a clinical trial, there is no control group to measure the change in these men’s sexual risk-taking against. So there is no way to tell if the group would have changed their risk-taking in a similar pattern if they had not been taking PrEP.

One thing is clear, however: These men would have been at very high risk of contracting HIV had they not been taking PrEP while engaging in the same level of sexual risk-taking. The evidence is in their very high rate of STIs. Six months into taking PrEP, 30 percent of the PrEP users had been diagnosed with at least one STI. After a year, half of them had contracted one or more STIs, with 33 percent diagnosed with a rectal STI, 33 percent with chlamydia, 28 percent with gonorrhea, and 5.5 percent with syphilis. As noted, two of them contracted hep C.

“Without a control group, we don’t know if these STI rates were higher than what we would have seen without PrEP,” stressed the paper’s co-author Julia Marcus, PhD, MPH, postdoctoral fellow at the Kaiser Permanente Division of Research. “Ongoing screening and treatments for STIs, including hepatitis C, are an essential component of a PrEP treatment program.”

No one in the group has been diagnosed with HIV.

Our takeaway, PrEP is clearly doing its job in HIV prevention, however we need to remain vigilant in testing and treatment for STIs. The choice to use or not use condoms is up to the individual, but be aware of the risks and ensure that you're regularly being tested to protect your health and potentially that of your sexual partners.

Thoughts on the study's findings, Instincters?

Comments

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Horrid pharmaceutical propaganda. 20 years of campaign and prevention thrown away. 20yo's today practice BB because of this and are contracting and passing on STD's as always. Shame on you 

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The shift here is no different from young hetros trusting the birth control pill to keep them safe from everything...it is stupid and wrong. However, it does mostly prevent unwanted kids (when used right).

Tackling the spike in other STDs is a separate issue. Teaching people that PreP + condom is the best choice for most encounters is just like teaching straight/bi folks the BCP + condom is the best choice. 

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Meh! The 20 year olds are not practising bareback sex BECAUSE of this. They were doing that BEFORE this even was a thing. Your 20 years of campaigning stopped working. The shame is on you. 

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As a health care provider, I see the great benefit to PrEP, but should still be used with caution.   People taking the medication must be as responsible with their own health and vigilant about STIs.   Also, the patient must be taking it everyday to prevent infection, no missed doses.   My only future concern is the virus changing due to many people using Truvada in high risk areas.  I don't know how true this can be because all bacteria and viruses work different, but I'm afraid of HIV changing and becoming resistant to Truvada.    My message and thought: Stay vigilant, cautious, aware  and knowledgeable as best you can be to protect yourself and others.

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Truvada interrupts infection / seroconversion which means it prevents viral reproduction. This makes mutation incredibly unlikely. The risk would be if people were getting infected despite Truvada and kept taking it anyway without the other half of the cocktail. That *could* create a PreP resistant version.

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As a microbiologist, prep is actually creating a heard immunity to those not taking prep. If more people are taking prep than a bigger herd immunity will be created. As far as creating a resistant virus, yes that is true, but there always be a new emerging disease until the end time. In the mean time, prep is working so keep in taking and thank you all for using prep and stopping HIV from spreading.

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this drug should be free to anyone that wants it

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Completely agree, Most LGBT centers provide free condoms to prevent AIDS/HIV, why not provide PrEP for everyone to really minimizing the contraction of AIDS/HIV !

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Probably because it costs about $50 a pill sticker price. Only the really poor (on government healthcare) and better off are targeted for PrEP. Those with no insurance can get it free, but those in the middle who prudently have insurance can find funding for the treatment through third party organizations... donated to by the drug compan. :P

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I'm glad that this study is being published and people will be made aware..  PrEP works

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