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Message Board > Special Interest Forums & Discussion Groups > Sex Advice: Ask and Give Advice   New CDC Estimate: PrEP Is One Part Of Preventing 185k New US HIV Infections, But...

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Old 4th March 2016, 09:49 AM
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Bob S: Administrator / Manager / Editor
 
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New CDC Estimate: PrEP Is One Part Of Preventing 185k New US HIV Infections, But...

Here's a quick summary of what appears below:
  • CDC releases paper about using testing, treatment, and PrEP to reduce new HIV infections
  • Advocate runs story about CDC paper highlighting PrEP
  • POZ reports on study of first case of man on PrEP contracting HIV
------------------------------------------------

The CDC had this press release last week: As many as 185,000 new HIV infections in the U.S. could be prevented by expanding testing, treatment, PrEP.

This was picked up by the Advocate as CDC: PrEP Will Help Reduce HIV Infections by (at Least) 70 Percent, which is a bit different emphasis.

This was at the Conference on Retroviruses and Opportunistic Infections in Boston where a paper was presented with four different scenarios of how the US might fair in achieving prevention and treatment goals by 2020. When I look at the press release in detail, I see this:

Quote:
The study also models the impact increased PrEP use by people at high risk of infection could have at current levels of viral suppression in the U.S., when the risk of HIV transmission is substantially higher. If testing and treatment rates were to remain the same over the next five years, expanding PrEP coverage alone could reduce new infections by nearly 20 percent, preventing more than 48,000 new HIV infections. Results suggest that as the nation works to expand the reach of HIV treatment, PrEP can play a critical role in protecting those currently at high risk for HIV infection.
The graphic of the four scenarios shows that the larger possible gains are through testing and treatment.

click on the image for larger view


It appears that the Advocate piece has spun this somewhat out of context. I believe PrEP makes great sense for HIV- men who have sex with other men; however, highlighting the 70% figure and the phrasing of their headline is a bit much.

Separately, POZ tells us PrEP Fails in Gay Man Adhering to Daily Truvada, He Contracts Drug-Resistant HIV.

Summarizing the story, researchers discovered the first case of an HIV- man who was taking Truvada daily as he should, had multiple instances of unprotected receptive anal sex, and developed HIV.

Quote:
“After 32 years of experience with HIV research, I have learned never to say ‘never’,” said Robert M. Grant, MD, MPH, a professor at the University of California, San Francisco, who was the head of the iPrEx trial that first proved PrEP’s effectiveness among MSM and transgender women in 2010. “Yet I also think that gay men benefit from feeling safer during sex, and I am grateful that PrEP affords that feeling.”

The man in the case study reported multiple acts of receptive anal intercourse without a condoms during the two-to-six week period before testing postivie for HIV. He has no reported history of injection drug use.

Pharmacy records indicated that the man had consistently filled his Truvada prescription on schedule. Dried blood-spot testing on a sample taken 20 days after he tested positive for HIV indicated that he had adhered well to Truvada during the previous one to two months, a period that overlapped with the estimated time when he contracted the virus. Additionally, a recent analysis of the blood sample the man gave for the test that first indicated he was HIV positive showed that he had high blood levels of both drugs included in Truvada at that time.

“This person claims he was taking PrEP every day and I believe him,” said Grant.
The man in this case is currently doing well on HIV treatment with a fully suppressed viral load.

Also from the piece, with Richard Harrigan, PhD, director of the lab program at the British Columbia Center for Excellence in HIV/AIDS in Vancouver:

Quote:
Reflecting on the new case study, Harrigan said, “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.”

Harrigan added, “This case demonstrates that while PrEP is beneficial, we can’t rely on it to be an infallible magic bullet.”
Although I'm in fact HIV-, I personally have been sexually abstinent for the last couple years due to personal circumstances. (How ironic that I run this web site...) If things were different, I would certainly get a Truvada prescription from my doctor.

As I've said before many times, I believe each person's sex life and health practices are a matter of individual choice based on making informed decisions. Your circumstances, life situations, and risk tolerance are different from mine. Therefore, I don't give advice but I do have some responsibility to members and guests of this site to help provide information.

You're free to make your own decisions, but I hope you'll stay aware of new developments that can affect what you and others do. Please feel free to add your own thoughts. I'm also going to add a link to this discussion on the CFS Home Page.

~ Bob S.
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Old 4th March 2016, 10:59 PM
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In Other News...

Quote:
HIV drug resistance to tenofovir, an antiretroviral drug vital to most modern HIV treatment and prevention strategies, is surprisingly and worryingly common.
From: Resistance to key HIV drug "concerningly common"

PrEP won't be effective forever either, folks. So far, latex still seems to be working.
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Old 5th March 2016, 10:51 AM
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Quote:
Originally Posted by pike View Post
From: Resistance to key HIV drug "concerningly common"

PrEP won't be effective forever either, folks. So far, latex still seems to be working.
I completely agree with Bob when he writes that

Quote:
I believe each person's sex life and health practices are a matter of individual choice based on making informed decisions. Your circumstances, life situations, and risk tolerance are different from mine. Therefore, I don't give advice but I do have some responsibility to members and guests of this site to help provide information.

You're free to make your own decisions, but I hope you'll stay aware of new developments that can affect what you and others do.
I also think that Pike has just hit the nail on the head, too.

A simple, totally inexpensive or even completely free thing such as the commonest condom has proven to significantly reduce the risk of seroconversion. I imagine that few guys may be allergic to latex. But I cannot quite think of any other serious, possibly life changing side effects associated with using condoms.

When you come to compare the complex costs and risks associated with both the PrEP and possibly the ensuing retroviral therapy vs. the good, ole latex...

My only hope is that each and everyone of us here may reach a personal decision that he may never regret.

KD
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Old 7th March 2016, 11:43 AM
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Bob S: Administrator / Manager / Editor
 
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I remember so many friends who dealt (and deal) with drug toxicities and then having to change from one drug to another. Makes me think of this song which actually was from 1983:

Huey Lewis And The News - I Want A New Drug

My housemate (former partner) is lucky to have been stable on Kaletra for years, not so lucky with his other health matters.

~ Bob
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Old 7th March 2016, 11:56 AM
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I'll reiterate one more thing. This actually is one of my rare pieces of advice: If you don't know your status or your last HIV test was not recent, get tested. Testing is knowledge. Knowledge is power.

Our doctor's caseload is primarily middle-aged or older Anglo (I mean White, for those who didn't live in South Texas in their youth) gays and somewhat younger Blacks and Latinos, a few older, of any sexual orientation. The highest rate of new infections in the US is among minorities.

I suspect members of those groups might not be reading this Message Board that much, but it's where the need is greatest.

~ Bob
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Old 7th March 2016, 01:42 PM
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Although ANY step forward in dealing with this disease is very welcome - with new drugs and treatments with little long term history or study - you never know what side effects may be found down the road.
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