Ryan Shea's picture

A New Case in PrEP Failure Has Some Loose Ends

PrEP has been a controversial topic in the gay community for many years since it started becoming widely used in the early 2010's as a way for men to minimize their chances of contracting HIV.

Currently, there are two publicized cases of men who contracted HIV while practicing PrEP, which has made critics of the drug believe it's faulty.  There is one case in particular that is turning heads, which was presented at February’s Conference on Retroviruses and Opportunistic Infections. During the conference, there were claims that an Amsterdam man adhering to PrEP was contracted by a strain of HIV that was non-drug-resistant.

Even with all this data, researchers have discovered a new theory that might negate those particular claims.

The theory being that the man only contracted HIV once he stopped practicing PrEP.  Per HIV Plus Mag: only when the man stopped practicing PrEP did the HIV begin to spread from his rectal tissue to the rest of his immune system, thus turning it from localized to systematic. 

In other words, PrEP switched from pre-exposure prophylaxis to post-exposure prophylaxis, and as a result, it kept the virus from spreading further into his body so long as he continued to practice PrEP. 

The man in question was taking part in a program known as AmPrEP demonstration, an HIV prevention study investigating PrEP practice among gay and bisexual men in the Netherlands. 

He then documented his sexual experiences on a phone app, which resulted in him having 50 partners in three months.  37 of which were condomless where he was primarily the receiver.  This led to him being diagnosed with anal chlamydia and gonorrhoea.  

The day he was diagnosed with HIV, he was also diagnosed with rectal Lymphogranuloma venereum (LGV). Following his positive diagnoses, he immediately started antiretroviral therapy with tenofovir, emtricitabine, darunavir and dolutegravir. 

For this particular case,  researchers say HIV didn’t become detectable until a month after the diagnoses. One doctor suggests that those particular results were consistent to him having a localized infection within the real tissues.  The other theory in this is that he didn't contract HIV at all during that point in time, but in fact what had been seen was actually an immune reaction to HIV in the presence of PrEP.

One might argue that if we had continued PrEP or had started combination therapy immediately, the infection could have been aborted, and with the knowledge gained from this case, one might consider this in future comparable cases,” the authors of the study concluded.

What are your thoughts on PrEP, do you think this case helped or hurt the cause?