This article by Trenton Straube first appeared on Poz.com here.
Ever since July 2012, when the FDA approved Truvada as PrEP, a pre-exposure prophylaxis to prevent getting HIV, its success rate has been, well, perfect. In fact, not a single person adhering to the daily regimen has ever tested HIV positive—and that includes everyone in clinical trials and studies, and the more than 40,000 people taking Truvada as PrEP in the United States. But PrEP researchers, like most scientists, rarely speak in absolutes and guarantees; they’ve acknowledged that, under rare circumstances, an infection is feasible. Last week, that hypothetical situation became a known reality.
On February 25 at the annual Conference on Retroviruses and Opportunistic Infections (CROI) in Boston, David C. Knox, MD, an HIV specialist at the Maple Leaf Medical Clinic in Toronto, presented data on a patient who, after two years of good PrEP adherence, tested HIV positive (for more on that, read this article by POZ’s Benjamin Ryan).
In Knox’s presentation, his patient remained anonymous, but many of us in the PrEP and HIV communities had followed his seroconversion story in real time as he posted about it last May in the Facebook group PrEP Facts: Rethinking HIV Prevention and Sex, in which he was an active member. Since then, Joe — as he prefers to be called here — dropped off the discussion boards. I had kept his information and interviewed him earlier this year for a potential POZ feature. At that time, the 44-year-old was excited to put 2015 behind him (more on that later). We chatted about gentrification in Toronto’s “gay village,” and he described himself as a “foreigner” whose family had lived in Kuwait and Denmark before moving to Canada when he was 11, experiences that resulted in his speaking several languages and working as an international flight attendant for 14 years. Now employed at a telecommunications giant, Joe sounded optimistic about his future job prospects and he was devoting energy to the new love of his life: Oliver, a Lhaso Apso-Maltese-Yorkie mix. Importantly, Joe had acclimated to a new HIV regimen, taking his meds each morning, and his viral load had remained undetectable.
We spoke again after his doctor’s CROI presentation, which resulted in Joe’s PrEP failure making international headlines. The following interview is compiled from our conversations and has been edited for length and clarity.
Let’s start at the beginning: How did you first hear about PrEP?
In November 2012, my doctor, Malcolm Hedgcock from the Maple Leaf Medical Clinic, which deals primarily with HIV-positive people in Toronto, published an article about PrEP in Outlook, one of the gay rags in Canada. I went to see him, and he said, “You’re the second person to voluntarily want to go on PrEP.” As you know, you have to have an HIV test come back negative, then you can’t do anything risky for three months before you have another HIV test, and if that’s negative you can go on PrEP. So all that happened. I passed all of their tests, and I think I started taking it in February or April 2013.
To read the rest of the story go here.