Preview above: Nic Holas on the moment he told his friends and family he was HIV positive.
Preventive HIV medication known as PrEP already plays a key role in curbing the HIV epidemic.
We’ve been told that just one pill a day of PrEP practically eliminates the chance of contracting HIV.
But now a man from Sydney is the seventh person in the world to become HIV positive despite taking the drug.
How effective is PrEP, and how much confidence can we place in a drug commonly described as a “game-changer”?
We've come a long way with HIV treatment
The situation was so dire in the 80s and 90s that hospital wards were set up around the globe, solely to care for patients diagnosed with the virus. No treatments were available and medical staff had the difficult job of trying to make patients comfortable as they died from AIDS (Acquired Immune Deficiency Syndrome).
When it comes to nasty infections there are plenty, but HIV (Human Immunodeficiency Virus) would have to be one of the worst. The virus is transmitted by vaginal or anal sex, and from contact with contaminated needles or blood.
As soon as HIV enters the body, it’s identified by immune cells (CD4 T-cells). Foreign invaders are usually destroyed by the immune system, but HIV is different. The virus penetrates the cell wall, unravels its genetic code, inserts itself into human DNA, and hijacks the cell for its own nefarious purposes.
Immune cells are distracted from their usual duties and become factories for producing and releasing billions of viral particles. HIV spreads throughout the immune system, taking cells captive until the immune system is exhausted. Eventually the body is left without any protection, vulnerable to even the simplest of infections.
But this tale has a happy ending, because HIV is no longer a death sentence.
HIV can be managed by taking one pill a day (in most cases) and now AIDS is rarely seen in Australia. HIV/AIDS wards have closed down because they’re not needed any more.
Anyone diagnosed with HIV can expect to live a long and healthy life - and modern medicine is so amazing that we even have drugs to prevent getting HIV in the first place!
PrEP is still the best protection we’ve got against new HIV infections according to Dr Brad McKay. Source: SBS
What’s the difference between continuous and intermittent PrEP?
PrEP works best when adequate doses are already in the body before exposure to HIV occurs.
Continuous PrEP is when one tablet is taken every day on an ongoing basis. This may be for just a few months, or for many years.
One tablet needs to be taken every day for at least seven days, before drug levels are high enough to protect against HIV from anal sex, and at least 20 days to protect against HIV from vaginal sex.
But it’s understandable if you don’t want to continuously take tablets every day if you’re going through a dry spell.
Intermittent PrEP (also known as ‘on demand’ PrEP, or ‘disco dosing’) is when people take PrEP for a few days at a time, around the time they’re having unprotected sex.
Intermittent PrEP involves taking two tablets at least 2 hours before having sex, then one tablet at the same time every day, until at least two tablets have been taken since the last time having unprotected sex.
PrEP “on demand” can be used for anal sex because drug levels quickly rise in rectal tissue, but cannot be used for vaginal sex as it takes much longer for drug levels to build up within the wall of the vagina.
We’ll have a proper fairy tale ending when we’ve eliminated HIV from the planet, but until then we’ve still got a lot to celebrate.
Recently an Australian gay man using Intermittent PrEP became HIV positive. While this is unfortunate, it isn’t unexpected. We don’t know the exact circumstances that led to this new infection, but we do know that thousands of people have been protected by using Intermittent PrEP successfully.
Continuous PrEP offers better protection than Intermittent PrEP because regular dosing allows more time for the drug to accumulate in higher concentrations.
How effective is PrEP?
Nothing is 100 per cent perfect, but PrEP is still the best protection we’ve got against new HIV infections.
PrEP has been used by approximately 450,000 people around the world, and so far we’ve only seen seven documented cases of people taking PrEP and becoming HIV positive.
What is U=U?
U=U (Undetectable = Untransmittable) means that people living with HIV who take their medication regularly and reduce the amount of HIV in their blood to undetectable levels are no longer at risk of transmitting HIV to their sexual partners. This scientific update has understandably been a massive relief for people living with HIV and their sexual partners.
We’ll have a proper fairy tale ending when we’ve eliminated HIV from the planet, but until then we’ve still got a lot to celebrate.
Insight asks; What's it like to live with HIV in 2019? Find out Tuesday April 2 at 8:30pm on SBS and SBS On Demand.
