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May26

Positive on PrEP

Thursday, 26 May 2016 Written by // Guest Authors - Revolving Door Categories // As Prevention , Treatment Guidelines -including when to start, General Health, Sexual Health, Health, Treatment, Revolving Door, Guest Authors

From POZ, guest author Trenton Straube offers insight into PrEP failure and what it means for HIV prevention

Positive on PrEP

Meet three guys who got HIV after starting Truvada as pre-exposure prophylaxis. How does this happen, and how are they doing today?

By Trenton Straube

If you take Truvada daily, the antiretroviral pill reduces your chances of contracting HIV by 99 percent. The FDA approved Truvada as a pre-exposure prophylaxis (PrEP) in 2012, but the drug only recently gained traction, with more than 40,000 people now taking it in the United States; thousands more have taken it in clinical trials and studies. In all those cases, no one got HIV while adhering to the daily regimen. That is, except “Joe,” a Toronto man whose case was detailed earlier this year at an HIV conference. POZ had the exclusive interview with Joe—you can read his sexually frank Q&A here—but he is not the only one to test HIV positive after starting PrEP. Here, we speak with two others. Their three stories offer insight into how this happens and what it means for HIV prevention.

Anthony’s Story

As a sexually active, openly gay grad student in Baton Rouge, Louisiana, Anthony Basco didn’t think he was at risk for HIV. But then one of his sex partners contracted syphilis and told him to get tested. Although easy to cure, syphilis can be deadly, so Anthony got checked out, despite not showing signs of infection. The test made a lasting impact. “When I realized I had syphilis, it was a reality check,” he says. “I thought, I need to do more to protect myself because I’m not invincible.”

While getting his syphilis treatment—a series of shots—Anthony asked his doctor about PrEP. The physician wasn’t well versed on the subject but promised to research it. They decided Anthony was a candidate, and after taking two HIV tests a month apart to confirm his negative status, Anthony started Truvada in September 2013. “Immediately, I experienced flu-like symptoms that I attributed to side effects,” he recalls. “So I discontinued the medication without consulting my doctor.” A few weeks later, he gave it another try; this time he felt only mild and short-lived gastrointestinal distress. He figured his body had acclimated to the Truvada.

That December, he went in for his three-month checkup, as is recommended for everyone on PrEP—docs look at kidney function, which is a possible concern for Truvada users, and for sexually transmitted infections (STIs). “It was the first time I didn’t have anxiety about it,” Anthony says. But he tested positive for HIV. As instructed, he stopped taking Truvada while genotype testing determined what type of HIV he had and which treatment he needed. When he got the news, he called up friends. “They came over and stayed the evening,” Anthony says. “It helped a lot. Plus, I was already working in the HIV field, so I knew it wasn’t a death sentence.”

Within a month, Anthony began a new regimen and has been undetectable since March 2014, though he says the meds have caused him to gain weight. Today, the 25-year-old works at HIV/AIDS Alliance for Region Two and its affiliated Baton Rouge Wellness Center, where he helps people navigate their sexual health needs, including access to PrEP.

This article previously appeared on the POZ. website. To read the rest of it go here.