PrEP Not a Substitute for Safe Sex

Here at One Medical we write a lot of prescriptions for PrEP, as it is highly effective at preventing HIV transmission, and there are currently at least 100,000 people on PrEP nationwide.

But a recent report of PrEP failure reminds us that there are strains of HIV resistant to Truvada.

The report described a PrEP user in New York City. He acquired HIV from a casual partner whose virus had multiple drug resistance mutations, including resistance to Truvada. The patient had been using condoms prior to starting PrEP, but stopped doing so once he started Truvada. Drug level testing in blood and hair samples was consistent with a high level of adherence to Truvada, and the patient and his partner both were certain he had been 100% adherent. This is the second case of resistant HIV in a PrEP user.

The concern with PrEP has always been that patients will stop using other safe-sex methods, and this is indeed what happened in the case above.

But our concerns go beyond the risk of acquiring a resistant strain of HIV. The incidence of STD’s is also continuing to rise – the most recent CDC data show a relentless increase in the number of cases of syphilis, gonorrhea and chlamydia infections.

If you’re using PrEP, please remember:

• PrEP is not going to protect you from a strain of HIV resistant to Truvada unless other protective measures are used all the time for all forms of sexual activity.
• PrEP does not protect against other STD’s; it is just an adjunct (and not a substitute) for other forms of protection, most especially condoms.
• If you are using PrEP, you should adhere to a schedule of HIV testing every 3 months (along with a serum creatinine every six months to screen for drug toxicity) – this protects you and your partners, and should reduce the emergence of drug-resistant strains; we also encourage testing for other STD’s at these visits.

The incidence of STD’s continues to increase, and our nation’s healthcare services are severely strained trying to keep up; the cost, in both economic and human terms, is immense.

We encourage our high-risk patients, including those who have a partner who is HIV positive, to discuss the pros and cons of PrEP with their provider.