&lt;hr /&gt;
&lt;p style=&quot;-qt-block-indent: 0; text-indent: 0px; margin: 0px;&quot;&gt;&lt;span style=&quot;color: #999999;&quot;&gt;Written by Dr.Deyn Natthakhet Yaemim, 24 March 2018&lt;/span&gt;&lt;/p&gt;
&lt;p style=&quot;-qt-block-indent: 0; text-indent: 0px; margin: 0px;&quot;&gt;&lt;span style=&quot;color: #999999;&quot;&gt;Medically Reviewed and updated by Dr.Deyn Natthakhet Yaemim, 9 March 2021&lt;/span&gt;&lt;/p&gt;
&lt;p style=&quot;-qt-block-indent: 0; text-indent: 0px; margin: 0px;&quot;&gt;&amp;nbsp;&lt;/p&gt;
&lt;p style=&quot;-qt-block-indent: 0; text-indent: 0px; margin: 0px;&quot;&gt;&amp;nbsp;&lt;/p&gt;
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&lt;h4&gt;&lt;strong&gt;Q: What is PrEP?&lt;/strong&gt;&lt;/h4&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;A: PrEP means Pre-Exposure Prophylaxis, and it&#39;s the use of anti-HIV medication that keeps HIV negative people from becoming infected.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h4&gt;&lt;strong&gt;Q: What is&amp;nbsp;Wild-type&amp;nbsp;HIV?&lt;/strong&gt;&lt;/h4&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;A: Is the HIV in its most natural state, non-mutated strain of a virus.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h4&gt;&lt;strong&gt;Q: What is&amp;nbsp;drug resistant&amp;nbsp;HIV?&lt;br /&gt;&lt;/strong&gt;&lt;/h4&gt;
&lt;p&gt;A: &lt;span style=&quot;color: #99ccff;&quot;&gt;This means the ability of HIV to&amp;nbsp;&lt;strong&gt;mutate&lt;/strong&gt;&amp;nbsp;and&amp;nbsp;&lt;strong&gt;multiply&lt;/strong&gt;/reproduce itself in the presence of antiretroviral drugs that usually kill them (HIV treatment and PrEP).&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h4&gt;&lt;strong&gt;Q:&amp;nbsp;How does&amp;nbsp;drug resistant HIV happen?&lt;/strong&gt;&lt;/h4&gt;
&lt;p&gt;A:&amp;nbsp;&lt;span style=&quot;color: #99ccff;&quot;&gt;Here&#39;s how&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;strong&gt;Transmission of drug-resistant HIV.&lt;/strong&gt;&amp;nbsp;Most HIV positive people are infected with wild-type HIV but around 10% are infected with drug-resistant HIV.&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Many HIV-positive people now take HIV drugs for treatment. If someone&#39;s HIV has developed resistance to one or more of these HIV drugs and has unprotected sex or shares needles with other who is not infected, it is possible that they can infect their partner with a drug-resistant HIV.&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;strong style=&quot;color: #99ccff;&quot;&gt;Before HIV treatment.&amp;nbsp;&lt;/strong&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;Even if someone is infected with wild-type HIV, genetic changes&amp;nbsp;still happen, even before treatment is started. This ends up creating a large mixture of virus in the body. Some of these variants contain the necessary mutations that can partially, or fully, resist an antiretroviral drug.&amp;nbsp;&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;strong style=&quot;color: #99ccff;&quot;&gt;During treatment.&amp;nbsp;&lt;/strong&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;After combination HIV drug treatment is started, the amount of wild-type virus is dramatically reduced to&amp;nbsp;&lt;/span&gt;&lt;a style=&quot;color: #99ccff;&quot; title=&quot;UNDETECTABLE FAQ&quot; href=&quot;https://sathornclinic.jimdo.com/u-u/&quot;&gt;undetectable level&lt;/a&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;.&amp;nbsp;If we keep the HIV suppressed, the mutation to drug-resistance won&#39;t happen. However, if the amount of virus isn&amp;rsquo;t pushed down and kept at very low levels, HIV variants can continue replicating, acquiring additional mutations. And once the virus has accumulated enough mutations, a high level of resistance to the drugs being used can occur, causing viral load to increase and CD4 cells to drop.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;HIV treatment halted and poor treatment adherence.&amp;nbsp;HIV&amp;nbsp;treatment only&amp;nbsp;work perfectly when taken exactly as prescribed.&amp;nbsp;&lt;strong style=&quot;color: #99ccff;&quot;&gt;Abrupt discontinuation of treatment (&lt;/strong&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;such as skipping doses, not taking&amp;nbsp; medication correctly, not getting refilled because of COVID-19 or because of chemsex or because simply forgot the appointment or stuck in country where HIV meds are not available) can cause the amount of an HIV drug to decrease in the bloodstream. If the drug level becomes too low, HIV can reproduce more freely and accumulate additional mutations. There are a number of reasons why someone might struggle with treatment adherence, including side effects, chemsex, COVID-19, a hectic schedule, forgetfulness, poor schedule management. If you&amp;rsquo;ve been having difficulty adhering to your drug regimen, it&amp;rsquo;s nothing to be embarrassed about&amp;mdash;be sure to tell our doctor so that we can up with solutions.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;strong&gt;While taking PrEP.&lt;/strong&gt;&amp;nbsp;&lt;span style=&quot;color: #3366ff;&quot;&gt;&lt;a style=&quot;color: #3366ff;&quot; title=&quot;https://www.fda.gov/news-events/fda-brief/fda-brief-fda-continues-encourage-ongoing-education-about-benefits-and-risks-associated-prep&quot; href=&quot;https://www.fda.gov/news-events/fda-brief/fda-brief-fda-continues-encourage-ongoing-education-about-benefits-and-risks-associated-prep&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;In the US, Truvada was approved&amp;nbsp;by US Food and Drug Administration (FDA) in July 2012 to prevent people from HIV&lt;/a&gt;. But&amp;nbsp;&lt;a style=&quot;color: #3366ff;&quot; title=&quot;http://www.croiconference.org/sessions/initiating-prep-during-acute-hiv-infection-what-risk-arv-drug-resistance&quot; href=&quot;http://www.croiconference.org/sessions/initiating-prep-during-acute-hiv-infection-what-risk-arv-drug-resistance&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;there is the possibility that PrEP could be started in&amp;nbsp;people&amp;nbsp;who are newly infected with HIV&lt;/a&gt;,&lt;/span&gt; but HIV tests that we use nowaday&amp;nbsp;can&amp;nbsp;not detect their infection.&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h4&gt;&lt;strong&gt;Q: Why Is PrEP and Drug Resistance a Concern?&lt;/strong&gt;&lt;/h4&gt;
&lt;p&gt;A:&amp;nbsp;&lt;span style=&quot;color: #99ccff;&quot;&gt;We know that PrEP works very well to prevent HIV infection when taken correctly and consistently, we prove that PrEP works well by checking your HIV status&amp;nbsp;through testing. However, there are a lot of people&amp;nbsp;who don&#39;t want to get tested and&amp;nbsp;start PrEP. Those who don&#39;t get tested doesn&#39;t mean they don&#39;t have HIV. Maybe they just&amp;nbsp;&lt;strong&gt;DON&#39;T KNOW&lt;/strong&gt;&amp;nbsp;they have it.&amp;nbsp;&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;They&amp;nbsp;may start PrEP before they&amp;nbsp;&lt;strong&gt;know&lt;/strong&gt;&amp;nbsp;they are infected, or they can become infected with HIV while using PrEP. If this happens, the virus in their body could change, or&amp;nbsp;&lt;strong&gt;mutate&lt;/strong&gt;, and become resistant to these ARV drugs.&amp;nbsp; People who have HIV typically need to take 3 ARV drugs to stop the virus from making copies of itself (also called replicating). When drug resistance occurs, some ARVs are no longer able to stop HIV from multiplying and the person would need to start taking a different combination of ARV drugs and 10 times more expensive. Ultimately, this means that the PrEP user may have fewer choices of the ARV drugs that they can use for treatment when they become infected with drug resistant HIV.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;/div&gt;
&lt;/div&gt;
&lt;/div&gt;
&lt;div class=&quot;cc-m-hgrid-column last&quot;&gt;
&lt;div id=&quot;cc-matrix-5721887525&quot;&gt;
&lt;div id=&quot;cc-m-18462535325&quot; class=&quot;j-module n j-text &quot;&gt;
&lt;h4&gt;&lt;strong&gt;Q: Why&amp;nbsp;do some people not get tested before taking PrEP?&lt;/strong&gt;&lt;/h4&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;A: There can be many reasons, according to my 6 years experiences they;&lt;/span&gt;&lt;/p&gt;
&lt;ul&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;strong&gt;are&lt;/strong&gt;&amp;nbsp;stigmatized and have fear to get tested.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;strong&gt;are&lt;/strong&gt;&amp;nbsp;worried doctors in their city will not be nice to them.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;strong&gt;are&lt;/strong&gt;&amp;nbsp;worried that their doctors will report it to the government.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;strong&gt;are&lt;/strong&gt;&amp;nbsp;afraid of positive HIV result because they know they have been having risks or high risk lifestyle.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;strong&gt;are&lt;/strong&gt;&amp;nbsp;ignorant people which cover simply don&#39;t know or simply stupid.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;strong&gt;think&lt;/strong&gt;&amp;nbsp;they&#39;re fine, they think they don&#39;t have HIV. So no need for a test.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;strong&gt;don&#39;t&lt;/strong&gt;&amp;nbsp;want to pay for a test or doctor fee.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;strong&gt;are&lt;/strong&gt;&amp;nbsp;lazy, they don&#39;t want to wait at clinic or hospital to get tested and PrEP.&lt;/span&gt;&lt;/li&gt;
&lt;li&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&lt;strong&gt;are&lt;/strong&gt;&amp;nbsp;concerned about their privacy. They want to be discreet. Going to healthcare providers in many cities can be a nightmare.&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;- so they buy PrEP from online pharmacy or from street pharmacy because it&#39;s easier, faster, and they can save some money. They are putting themselves and everyone at risks.&lt;/span&gt;&lt;/li&gt;
&lt;/ul&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h4&gt;&lt;strong&gt;Q: I don&#39;t want frequent doctor visit can I buy PrEP from pharmacy without getting test?&lt;/strong&gt;&lt;/h4&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;A: If you don&#39;t get tested and proceed with PrEP, later on when you find out you are HIV positive with drug resistant HIV, you&#39;ll not be able to avoid frequent doctor visit as a HIV positive person. And you will have to do that for the rest of your life if you don&#39;t want your HIV infection to develop to AIDS. If that happens, don&#39;t say I never warn you. We allow people to refill PrEP by buying online from our pharmacy only if they have prescription from their doctor beforehand.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h4&gt;&lt;strong&gt;Q: Will drug resistance become a bigger problem when PrEP is rolled out at larger scale?&lt;/strong&gt;&lt;/h4&gt;
&lt;p&gt;A: Maybe,&amp;nbsp;&lt;strong&gt;possibly&lt;/strong&gt;. &lt;span style=&quot;color: #99ccff;&quot;&gt;We do know that the risk of drug resistance was low in completed clinical trials where study participants were assigned to take a daily PrEP. But the risk of drug resistance in the &amp;ldquo;real world&amp;rdquo; may differ because:&amp;nbsp;&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;-&amp;nbsp;In clinical trials, study participants received free HIV testing&amp;nbsp;&lt;strong&gt;ONCE A MONTH&lt;/strong&gt;&amp;nbsp;which allowed research clinicians to immediately stop PrEP use once infection was identified; in the real world, HIV testing may&amp;nbsp;be done every three months,&amp;nbsp;or different intervals, or&lt;strong&gt;&amp;nbsp;NOT DONE AT ALL&lt;/strong&gt;&amp;nbsp;!!!&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;-&amp;nbsp;We do not know how well each PrEP users take their PrEP; when PrEP is not taken consistently, risk of HIV infection is greater and more chance for drug resistant to develop.&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #3366ff;&quot;&gt;-&amp;nbsp;&lt;a style=&quot;color: #3366ff;&quot; title=&quot;http://www.croiconference.org/sessions/initiating-prep-during-acute-hiv-infection-what-risk-arv-drug-resistance&quot; href=&quot;http://www.croiconference.org/sessions/initiating-prep-during-acute-hiv-infection-what-risk-arv-drug-resistance&quot; target=&quot;_blank&quot; rel=&quot;noopener&quot;&gt;There is the possibility that PrEP could be started in&amp;nbsp;people who are newly infected with HIV&lt;/a&gt;, &lt;/span&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;but HIV tests that we use nowaday&amp;nbsp;can not detect their infection, you can miss the diagnosis even in tight control setting as in research.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;h4&gt;&lt;strong&gt;Q: What can I do?&lt;/strong&gt;&lt;/h4&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;A: If you&#39;re on PrEP, don&#39;t put yourself at this risk. Don&#39;t fuck with any people who&#39;s taking PrEP without getting tested. If they tell you they&#39;re on PrEP, ask them when was the last time they get tested. They should have blood test results on their email address or a photo of their last test results. There are people who even fake their blood test results just to fuck bareback with you guys. And trust me, short course of&amp;nbsp;heavenly fun is not worth the risk to fuck with the wrong guy.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;- Take PrEP as prescribed.&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;- Don&#39;t create your own way of taking PrEP.&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;- Don&#39;t share your PrEP to anyone else who&#39;s not tested.&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;- If you want to take PrEP, you get tested before!&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;- If you&#39;re taking PrEP, get tested as suggested!&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;- Tell your friends and who you fuck with to do it right.&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;- Don&#39;t fuck with those who don&#39;t do it right. We have been doing a lot of hard work together in order to keep you safe.&lt;/span&gt;&lt;/p&gt;
&lt;p style=&quot;text-align: center;&quot;&gt;&lt;span style=&quot;color: #99ccff;&quot;&gt;&amp;nbsp;&lt;span style=&quot;color: #ff00ff;&quot;&gt;&lt;em&gt;&lt;strong&gt;DON&#39;T FUCK IT UP OURSELVES AND DON&#39;T LET SOMEONE ELSE FUCK IT UP!&lt;/strong&gt;&amp;nbsp;&lt;/em&gt;&lt;/span&gt;--- Dr.Deyn&lt;/span&gt;&lt;/p&gt;
&lt;p style=&quot;text-align: center;&quot;&gt;&amp;nbsp;&lt;/p&gt;
&lt;/div&gt;
&lt;div id=&quot;cc-m-18462557325&quot; class=&quot;j-module n j-hr &quot;&gt;&lt;hr /&gt;&lt;/div&gt;
&lt;div id=&quot;cc-m-18462557525&quot; class=&quot;j-module n j-text &quot;&gt;
&lt;h4&gt;&lt;strong&gt;Further readings&lt;/strong&gt;&lt;/h4&gt;
&lt;/div&gt;
&lt;div id=&quot;cc-m-18464902325&quot; class=&quot;j-module n j-text &quot;&gt;
&lt;p&gt;&lt;span style=&quot;color: #3366ff;&quot;&gt;&lt;a style=&quot;color: #3366ff;&quot; title=&quot;COVID-19 AND HIV UPDATE&quot; href=&quot;https://sathornclinic.jimdo.com/covid19/&quot;&gt;- COVID-19 and HIV&lt;/a&gt;&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #3366ff;&quot;&gt;&lt;a style=&quot;color: #3366ff;&quot; title=&quot;COVID-19 AND SEXUAL HEALTH&quot; href=&quot;https://sathornclinic.jimdo.com/covid19sexualhealth/&quot;&gt;- COVID-19 and Sexual Health&lt;/a&gt;&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #3366ff;&quot;&gt;&lt;a style=&quot;color: #3366ff;&quot; title=&quot;COVID-19 AND PrEP&quot; href=&quot;https://sathornclinic.jimdo.com/covid19-prep/&quot;&gt;- COVID-19 and PrEP&lt;/a&gt;&lt;/span&gt;&lt;br /&gt;&lt;span style=&quot;color: #3366ff;&quot;&gt;&lt;a style=&quot;color: #3366ff;&quot; title=&quot;PrEP use and drug resistant HIV?&quot; href=&quot;https://sathornclinic.jimdo.com/prep-drug-resistant-hiv/&quot;&gt;- PrEP and Drug-Resistant HIV&lt;/a&gt;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&amp;nbsp;&lt;/p&gt;
&lt;hr /&gt;
&lt;h4 style=&quot;-qt-block-indent: 0; text-indent: 0px; margin: 0px;&quot;&gt;&lt;strong&gt;References&lt;/strong&gt;&lt;/h4&gt;
&lt;p style=&quot;-qt-block-indent: 0; text-indent: 0px; margin: 0px;&quot;&gt;1.&lt;span style=&quot;color: #3366ff;&quot;&gt;&lt;a style=&quot;color: #3366ff;&quot; href=&quot;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4054409/&quot;&gt;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4054409/&lt;/a&gt;&lt;/span&gt;&lt;/p&gt;
&lt;p style=&quot;-qt-block-indent: 0; text-indent: 0px; margin: 0px;&quot;&gt;2.&lt;span style=&quot;color: #3366ff;&quot;&gt;&lt;a style=&quot;color: #3366ff;&quot; href=&quot;https://www.poz.com/basics/hiv-basics/hiv-drug-resistance&quot;&gt;https://www.poz.com/basics/hiv-basics/hiv-drug-resistance&lt;/a&gt;&lt;/span&gt;&lt;/p&gt;
&lt;p style=&quot;-qt-block-indent: 0; text-indent: 0px; margin: 0px;&quot;&gt;3.&lt;span style=&quot;color: #3366ff;&quot;&gt;&lt;a style=&quot;color: #3366ff;&quot; href=&quot;http://www.croiconference.org/sessions/initiating-prep-during-acute-hiv-infection-what-risk-arv-drug-resistance&quot;&gt;http://www.croiconference.org/sessions/initiating-prep-during-acute-hiv-infection-what-risk-arv-drug-resistance&lt;/a&gt;&lt;/span&gt;&lt;/p&gt;
&lt;p style=&quot;-qt-block-indent: 0; text-indent: 0px; margin: 0px;&quot;&gt;4.&lt;span style=&quot;color: #3366ff;&quot;&gt;&lt;a style=&quot;color: #3366ff;&quot; href=&quot;https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(19)30404-7/fulltext&quot;&gt;https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(19)30404-7/fulltext&lt;/a&gt;&lt;/span&gt;&lt;/p&gt;
&lt;p style=&quot;-qt-block-indent: 0; text-indent: 0px; margin: 0px;&quot;&gt;5.&lt;span style=&quot;color: #3366ff;&quot;&gt;&lt;a style=&quot;color: #3366ff;&quot; href=&quot;http://www.croiconference.org/sessions/impact-prep-drug-resistance-and-acute-hiv-infection-new-york-city-2015-2017&quot;&gt;http://www.croiconference.org/sessions/impact-prep-drug-resistance-and-acute-hiv-infection-new-york-city-2015-2017&lt;/a&gt;&lt;/span&gt;&lt;/p&gt;
&lt;/div&gt;
&lt;/div&gt;
&lt;/div&gt;

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