Can I still get HIV if I’m on PrEP?

Illustration: Vadim Sazhniev

@AskPeaches: I read about someone who was on PrEP and took the drug as recommended but still contracted HIV. I thought it was very effective. How could this have happened?

@Stephen: There’s no silver bullet that is 100% fail-proof in preventing HIV infection. Proper condom use and PrEP are so far our safest bet. PrEP is 99% effective in preventing HIV when taken properly and consistently. This means that there’s still an approximate 1% chance that the drug might not work. So far, there have been some 11 officially reported cases of HIV infection when someone has been on PrEP where their adherence to the drug was verified or unverified. Researchers have been able to prove a person’s adherence to the drug by examining the amount of drug in their blood and hair samples. In some reported cases, the individuals contracted the virus because they were exposed to a strain of HIV that was resistant to several HIV drugs, including tenofovir and emtricitabine — the two-drug combination that makes up Truvada colloquially referred to as PrEP. In one case, the patient was not exposed to a drug-resistant strain but still caught the virus, and in another, it’s believed the individual may have been HIV-positive before going on Truvada.

I know that this can be unsettling, but this is a reason why clinicians recommend condom use in addition to PrEP. Given this extremely rare occurrence, however, experts still recommend using the drug, since you’re no more protected without it. For more information on PrEP and its proper usage, consult my prior post here. As I’m not offering medical advice, but information that is available publicly, please make sure to also consult your healthcare provider. 

Please stay informed and be safe!

The @AskPeacheas column is prepared by committee but written from one person’s experience. Send emails to askpeaches [at] freshfruitinc [dot] com with “@AskPeaches” in the subject line. Be sure to give enough background, so the advice can be more specific and relevant.

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