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What effect will PrEP have on resistance?

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I have been saying that since before the FDA approved PrEP.

As Ann pointed out, Truvada is 2 drugs.

But what if there was a 3-drug PrEP combo ?

In theory, you could still end up catching an HIV strain resistant to 1 or more of its components. The sample size in those PrEP studies seem pretty small, and the adherence seems low enough that it may not even matter. And then, who knows how many drug resistant strains the participant were actually exposed to, and which ones ?

Let's say our worst fears come true and drug resistant strains multiply. There is an instant fix that the pharmaceutical industry will love : they will create a a PrEP combo with even more drugs : 4, 5, 6,7, 8 drugs. Hell, why not a PrEP combo with all HIV drugs of every single class ? No damn HIV will ever get past that, will it ? Of course, the "patient" might not survive that kind of combo.

So yes, why worry ? I'd like to understand the FDA's thinking on this one.

Some of those issues also apply to PEP, but to a lesser degree than PrEP. In some cases you can know what kind of virus you were exposed to - in occupational settings when a syringe is involved, or even non-occupational setting if an accident happens and a known positive partner discloses their genotype and/or the drug combo they are on .

The thinking was, and continues to be stopping the spread of HIV. Sadly poor adherence by some individuals results in their becoming infected. Because of drug toxicity concerns and long-term side effects it was not recommended, by committee, to add a third drug to the cocktail. Really, really hard to change human behavior.


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