The First Truvada Failure Story Is Not a Reason for Panic

For the first time, a man taking PrEP according to approved guidelines has been diagnosed with a drug resistant form of HIV. What does this mean for the thousands of men currently using the drug?

Doctor David Knox of Toronto’s Maple Leaf Medical Clinic reports that a 43-year-old gay man who had been receiving PrEP has contracted HIV. While the man’s partner is HIV positive, he has an undetectable viral load due to antiretroviral therapy. The man has disclosed, however, that casual sexual encounters may have upped his risk of contracting HIV. He contends that he adhered to the daily PrEP schedule, and his drug refill pattern would appear to confirm his assertion.

However, in April 2015–just two years after beginning PrEP–the man began showing symptoms that align with a period of potential HIV exposure.

The man suffered a fever and abdominal pain so intense that he visited the hospital. Because his symptoms were somewhat atypical for early HIV warning signs, the man’s HIV status wasn’t examined at that time.

Later, the man came in for a routine HIV test–again demonstrating that he adhered to the PrEP guidelines of regular sexual health checks. He tested positive for the HIV p24 antigen, a marker of the virus that can be used to detect very early infection. Further analysis found that the man had acute HIV infection, but his use of PrEP may have blunted the virus’ powers to replicate itself.

Additional investigation confirmed that the patient most likely adhered to the appropriate drug schedule–though an interruption cannot be ruled out completely. The man also was found to have several markers for drug resistance including emtricitabine and tenofovir, key ingredients in Truvada, the drug he was taking. Truvada currently leads the PrEP drug market.

Doctor David Knox, in research presented to the 2016 Conference on Retroviruses and Opportunistic Infections, says that while we cannot rule out other factors, the data received from three separate tests would suggest this to be the first documented case of PrEP’s failure outside of medical trials.

The fact that PrEP could fail isn’t news. Studies suggest that if users do not stick to the daily regime, the drug’s effectiveness can be reduced. Furthermore, we already know that Truvada is only effective against the most common strains of HIV.

While daily PrEP is capable of providing significant HIV protection for most people, clinicians maintain that the prevention method isn’t foolproof. PrEP cannot protect people from other sexually transmitted infections, and condom use remains important, particularly for sexual relationships that involve multiple partners.

Thousands of other PrEP users are receiving adequate protection, so this isolated incident must be put in perspective. As health agencies have noted, since the rollout of Truvada, this is the first incident of drug resistance-failure out of the tens of thousands of people who are using PrEP to manage their sexual health. PrEP is, on the whole, working.

What is the major takeaway from this case, then? We must recognize Truvada’s potential shortcomings.

Richard Harrigan of the BC Center for Excellence in HIV/AIDS explains, “I certainly don’t think that this is a situation which calls for panic. It is an example that demonstrates that PrEP can sometimes be ineffective in the face of drug resistant virus, in the same way that treatment itself can sometimes be ineffective in the face of drug resistant virus.”

We must educate men who have sex with men (MSM) and other at risk populations that Truvada isn’t a magic bullet. It is only one of several methods of protection, including condoms and regular health screenings.

This incident certainly doesn’t make Truvada a failure. In fact, the findings give us greater insight into the potential of current PrEP drugs and identify where we need more research.

We need not panic, but instead, we must continue to protect ourselves with every reasonable method available.

Photo credit: Thinkstock.

43 comments

Siyus Copetallus
Siyus Copetallusabout a year ago

Thank you for sharing.

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Sarah Hill
Sarah Hill1 years ago

If you don't want to get pregnant, don't have sex. If you do, be careful, use precautions. If you do get pregnant, there are plenty of childless couples who would love to adopt your baby!

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Sarah Hill
Sarah Hill1 years ago

If you don't want to get pregnant, don't have sex. If you do, be careful, use precautions. If you do get pregnant, there are plenty of childless couples who would love to adopt your baby!

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Sherry Kohn
Sherry Kohn1 years ago

Many thanks to you !

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cynthia b.
cynthia l1 years ago

Sad thx for posting

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Sharon S.
Sharon S1 years ago

It's unfortunate

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Carole R.
Carole R1 years ago

Always use a condom, medication or not.

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Donna T.
Donna T1 years ago

thank you

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Jan N.
Jan N1 years ago

There will undoubtedly be others who think they can skip the condoms because they're taking the preventative. Wishful thinking.

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pam w.
pam w1 years ago

Despite our best care, condoms can break, come off, etc, and result in disease or pregnancies. It happens. Wishing him the best of luck.

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