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Author Topic: What effect will PrEP have on resistance?  (Read 2711 times)

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Offline tednlou2

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What effect will PrEP have on resistance?
« on: March 21, 2013, 01:16:15 AM »
I've been wondering what effect PREP will have on resistance.  If you take it as prevention and should become infected, are you at risk for creating resistance, if you aren't taking PREP meds consistently?  And, isn't PREP just mono-therapy Truvada?  Would you be infected and taking mono-therapy, which would likely lead to resistance?  And, then you may transmit a strain that is already resistant? 

I know I should be more educated on all this. 
« Last Edit: March 21, 2013, 07:01:48 AM by Ann »

Offline Matts

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HIV Prevention Pill Will Do More Harm Than Good
The side effects of Truvada PrEP outweigh its benefits, as people will struggle to take it regularly...

In the primary study of PrEP, participants were regularly counseled on taking their pills daily. They had monthly doctor visits, where they again were counseled on taking their medications. Further, they were paid to participate in the study. And yet, even with all this support, only 18 percent of the study participants were taking the pills with any regularity. In the real world, where people don't get paid to take medicine, and where people don't have medication counseling, the results will be even lower. And that's where the danger lies. Not taking Truvada for PrEP properly is more serious than just not having protection from HIV infection.

First, if a person taking Truvada becomes infected, there is a greater chance that their HIV will be resistant to Truvada. Currently, Truvada is the backbone of successful AIDS treatment. The creation of Truvada-resistant strains of HIV is incredibly worrying.

Second, Truvada has serious side effects, including kidney damage and bone loss. These risks may be acceptable when a person has HIV or AIDS, but people taking PrEP are healthy. There will be healthy people who will not get the preventive benefits of PrEP, but who will suffer kidney damage and other harms.

Third, many people, thinking they are protected by taking PrEP, will abandon or reduce the use of other proven preventive measures such as condoms. "Risk compensation," the phenomenon of engaging in more risky behavior when you believe you are protected from harm, has been documented in virtually all areas of life, including the sexual arena. Because many people will not take Truvada properly, but think they are protected, it is entirely likely that widespread use of PrEP will actually increase HIV infections....


Offline mecch

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Offline Ann

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Re: What effect will PrEP have on resistance?
« Reply #3 on: March 21, 2013, 07:22:18 AM »
Ted, I split your post out of the Test and Treat thread because "Test and Treat" is NOT PrEP and your question only clouded the issue being discussed. (I also edited your post to change the thread title, because I forgot to do it when I did the split.)

Test and Treat is putting someone on treatment immediately after they've tested positive.

PrEP is treating people before they've been infected, in an attempt to keep them hiv negative.

While Truvada is the only drug combo officially approved for PrEP so far, it is not actually monotherapy. Monotherapy means only one drug, but Truvada is TWO drugs. Sometimes Truvada on its own is also used for PEP.

Matts, what you posted is an opinion piece. There have been a lot of opinions regarding PrEP all over the internet, some for, some against, and some on the fence.

If anyone cares to read an article concerning some actual research (as opposed to opinion) surrounding PrEP, here you go...

Young Gay Men’s PrEP Study Shows Feasibility and Challenges

A small study of pre-exposure prophylaxis (PrEP) among young gay men in Chicago was able with some struggle to recruit willing participants, but it found there was a marked discrepancy between their reported and their actual adherence to the medication, aidsmap reports. The study’s findings echo recent disappointing results from the VOICE trial among African women, which was unable to design PrEP modalities appealing enough to lead to high adherence among that population.

Publishing their results of their placebo-controlled study in the Journal of Acquired Immune Deficiency Syndromes, researchers studied 58 gay men, most of them African American, Hispanic or mixed race, between the ages of 18 and 22 who had all reported unprotected anal intercourse during the past year. They divided the men into three study groups: One received once-daily Truvada (tenofovir/emtricitabine); a second received a placebo; and a third received neither medication nor placebo, but, like the other groups, attended a clinic each month where they could receive safer-sex counseling in addition to health monitoring. All participants received a group-based behavioral intervention.

According to self-reports, participants adhered to PrEP at a rate of 72 percent for the first two months of the study and at 80 percent in the subsequent four months. Drug-level monitoring contradicted this assertion: Adherence began at about 50 to 60 percent in the first three months of the study and then declined to 20 percent at the six-month point. Due to the fact that the drug-level test could only detect the medication taken during the previous 48 hours, however, it is feasible that participants took PrEP intermittently and that the screens could have failed to detect total usage.

The study authors concluded that their results show that it is feasible to establish a study of gay youth taking PrEP and that group interventions given with counseling and HIV testing found high acceptance among the participants. However, their data draw into question how to better design such a study to encourage high adherence to PrEP.

To read the aidsmap story, click here.

Ted, your questions IS a valid one, it just didn't really belong in the thread where you posted it. I'm also wondering how much PrEP may contribute to future cases of NRTI class resistance (Truvada is composed of two drugs from the NRTI class), given the disappointing aspects of this study where compliance was concerned.

Crickets, we're all going to hell in a handbasket. 

Mecch, sorry, I didn't notice your post when I split the thread. I understand you meant for this witticism to be in the Test and Treat thread, so feel free to repost it there. Again, my apologies that you slipped past me and got split along with Ted and Matts.
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Offline tednlou2

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Re: What effect will PrEP have on resistance?
« Reply #4 on: March 21, 2013, 11:54:36 PM »

No problem.  Oh, I had a brain fart with the Truvada mono-therapy thing.  I forgot it was actually two drugs. 

Offline madbrain

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Re: What effect will PrEP have on resistance?
« Reply #5 on: March 22, 2013, 04:44:34 AM »
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 .

Offline Mishma

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Re: What effect will PrEP have on resistance?
« Reply #6 on: March 26, 2013, 02:26:20 PM »
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.
2016 CD4 25% UD (less than 20). 30+ years positive. Dolutegravir, Acyclovir, Clonazepam, Lisinopril, Quetiapine, Sumatriptan/Naproxen, Restasis, Latanoprost, Asprin, Levothyroxine, Restasis, Triamcinolone.


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