Despite first reported infection, PrEP remains “hugely effective”

Don’t panic, say HIV experts, after the first case of a man becoming infected with HIV while on PrEP for two years was reported on Thursday

The 43-year-old Toronto gay man appeared to only recently have been infected after having unprotected sex with multiple partners, despite claiming to use the anti-HIV drug daily as prescribed.

It’s thought he contracted a rare strain of HIV that’s immune to the two ARVs in Truvada, the drug used as PrEP.

In a statement, Anova Health’s Health4Men project said that HIV infection while on PrEP is “exceedingly rare”, as PrEP (taken correctly) has been proven to be effective in preventing transmission by up to 92%.

“Like most viruses, HIV is an adaptive pathogen. It figures out ways to protect itself by building resistance to drugs that threaten it. It’s extremely unusual for a strain of HIV to develop resistance to both these ARVs; in fact, this is the first reported case of its kind in five years.”

Health4Men explained that, although rare, “there is a chance that you could get HIV while being on PrEP, if you have unprotected sex with someone infected with a multiple-drug-resistant strain of the virus.”

The organisation noted that not taking PrEP as prescribed also increases the chance of becoming infected.

“PrEP is still a hugely effective way to prevent transmission of HIV and has proven to work for thousands of HIV-negative high-risk men over a five-year period,” commented Ben Brown, a Technical Advisor to Anova and co-lead for its PrEP implementation project.

“This reality is supported by vigorous research that has resulted in PrEP being recommended for HIV negative gay and bisexual men by the World Health Organisation.

“Very few things in life work 100% of the time. Think seatbelt, bungee cord or condom. It works most of the time but once in a blue moon something prevents it from working like it should,” said Brown.

He pointed out that Health4Men has always recommended that PrEP be used together with other preventative measures to ensure you stay uninfected.

Practising sero-adaptive behaviours (knowing your HIV status and that of your partner/s and choosing certain sexual behaviours and positions accordingly), and consistent condom and lube use while taking PrEP make it nearly impossible become infected with HIV, added Brown.

Consistent condom and lube use will also protect you from other sexually transmitted infections such as syphilis, HPV, gonorrhea or chlamydia, which PrEP does not do.

In December, South Africa’s Medicines Control Council officially approved the use of PrEP as an HIV prevention medication.