An instance where a man who was infected with HIV while consistently taking the highly acclaimed HIV preventive drug, pre-exposure prophylaxis (PrEP) raised concerns over the effectiveness of this drug prevention drug.
A recent study that was published in The Lancet HIV journal put these concerns by showing the unique circumstances under which the infection took place.
According to the report, the man, whose case is the third case of PrEP failing showed that the patient was infected with non-drug-resistant HIV. In the other two cases the men were infected with multidrug-resistant HIV.
The researchers alluded that in the third case, PrEP could have stopped a contained HIV infection in the rectal tissue from circulating to the rest of the body. This infection only started spreading throughout the body system when the patient stopped taking PrEP.
High Risk Behaviour
According to the report, the man was 50 years old and had started taking PrEP in September 2015 after reporting very high numbers of condom free sex with 37 partner three months before he started taking PrEP.
He continued with his high risk behaviour even after starting PrEP with a reported 56 condomless sex partners between October 2015 and April 2016.
Between December 2015 and March 2016, he was also found to have chlamydia and gonorrhoea. On May 2016, almost eight months into the study, he was diagnosed with HIV as well as Lymphogranuloma venereum of the rectum (LGV).
He was then taken off PrEP to prevent him from acquiring drug-resistant HIV. He was instead put on antiretroviral therapy (ART) a month after his diagnosis.
Proper Adherence to PrEP Prescription
The man seemed to adhere fully to the daily PrEP regime. So how do we explain his subsequent HIV infection yet he was using PrEP as recommended?
The researchers suggest that the man’s HIV results were uniform with the man initially having a confined infection within cells in his rectal tissues when he was still on PrEP. The PrEP then prevented the infection from spreading further.
The other possibility is that the man was not actually infected at this point and what showed in the HIV tests was an immune reaction to HIV in the presence of PrEP.
Even though PrEP was stopped after the HIV positive test results, the therapy continued to offer some degree of preventative effect for about two weeks after withdrawal. This then led to lack of observable HIV viral load three weeks after PrEP was stopped and a month after the HIV positive test was done.
PrEP Not License To Go Condomless
From this case the researchers have recommended the use of combination preventive methods. This is because although PrEP prevents HIV infection, it does not prevent getting infected with other STIs. Studies have shown that STDs increase the chances of getting infected with HIV. It is therefore, to not only prevent HIV but to also keep people protected from STIs through the proper use of condoms.
Other Preventive Methods
For those who engage in casual sex, it is important to know your options when it comes to prevention. PrEP is the option to go for before an exposure happens – this is something to consider if you know you are going to be engaging in high-risk sexual behaviour in the future. During sex, it is important to use condoms to not only prevent HIV infection, but also other STD infections as well. If you do suspect you had an exposure within the last 72 hours then HIV PEP would definitely your option to go to – immediately contact a STD clinic like Shim Clinic to get tested for STDS including HIV and to be prescribed PrEP.
Source: Lancet HIV Journal 2017