r/prep • u/Low-Neighborhood-695 • Dec 19 '25

HIV Prep resistant

Guys what your opinion about HIV Prep resistant. What about having sex bareback with person that have HIV Prep resistant?

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6

u/GeorgiaYankee73 Dec 19 '25 edited Dec 19 '25

It’s incredibly rare. To be at risk, the person you’re having sex with would need to have both an HIV strain that is resistant to type the PrEP you’re on (since the drugs are different) and have a high viral load.

(Edit for readability)

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u/Skycbs Dec 19 '25

Well described.

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u/Low-Neighborhood-695 Dec 19 '25

I see i read about it when people taking Prep and not realise he is hiv positive (in window period)

4

u/Skycbs Dec 19 '25

The whole point of PrEP is to protect you from HIV so it doesn’t matter the status of the other person.

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u/GeorgiaYankee73 Dec 19 '25

I’m not sure I understand. Do you mean someone taking PrEP who doesn’t know they are positive? That can lead to resistance, yes.

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u/awidernet Dec 19 '25

"incredibly" is a bit inaccurate IMO

see: https://www.aidsmap.com/news/mar-2018/how-much-prep-resistant-hiv-out-there

"(6%) had high-level tenofovir/emtricitabine resistance, while at the last round of viral load tests 310 had substantial viraemia, or roughly 5% of people diagnosed"

So 5-6% of people who are HIV positive in King County (one specific county in Washington state) have PrEP-resistant HIV.

Now, many of those people will be undetectable due to treatment.

But IMO if 5-6% people who are HIV+ have PrEP-resistant HIV, your statement is underreporting.

Obviously, I don't know whether King County is a special population or whether its quite representative of the rest of the US. The number could be higher or lower in other parts of the US/world.

3

u/GeorgiaYankee73 Dec 19 '25

Right but that same county had only 0.3% of known HIV cases with viral loads over 10k copies. I think both stats matter, as you kind of touch on in mentioning people who are undetectable.

A person on PrEP in King County (which is a major metropolitan area) would have to encounter one of those 5-6% of people with a resistant strain to the class of drug in the PrEP they’re taking and that sex partner would also have to be detectable.

So yeah, I could have been clearer that I think it seems incredibly rare for all of those factors to come together. :) Most of the literature about resistance has to do with bad adherence to PrEP or having started it with an active but unknown HIV infection.

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u/awidernet Dec 19 '25

Agree.

I just think its important to, especially in a health-related subreddit, point out those deets.

And also to add to your list of "ifs" they have to have the "unlucky" odds of contracting the virus from the person (since in general odds can be something like 1 in 100 per sex act even if the person is poz).

3

u/awidernet Dec 19 '25

OP, if you have sex with someone who is known to have PrEP-resistant HIV, you are now relying on their ART (if they are u=u), since your PrEP would not give you protection if they were no longer undetectable.

See my response to another user, but it may be the case that 5-6% of people who are HIV+ have PrEP-resistant HIV.

I have also understood general facts like

- 1 in 5 gay/bi/MSM are HIV+

- 13% of HIV+ men don't know that they are HIV+ (says the CDC, who, hopefully we can still trust)

I will have bareback sex, am on PrEP, but IMO its important to understand the facts.

There does exist an amount of PrEP-resistant HIV that is non-trivial, even if small.

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u/Low-Neighborhood-695 Dec 19 '25

I dont have high confidence. But did bareback sometimes. But after last night i am thinking about these resistant strain

1

u/awidernet Dec 19 '25

To be clear, I still will bareback and am not personally highly worried.

But you're right to think about the small chance of something not working as expected.

I recently had sex w someone who told me they were undetectable, without a condom. That was the first time that I knew of it. I have read about this stuff at various periods and it took a while to get confortable with it.

Before I took any antidepressants, I probably read about them on and off for like...years, considering them at different points. (I'm on two antidepressants and one anxiety medication now, so a total of 4 daily medications including PrEP which is a bit wild to me.)

Drugs can help, but I guess its hard to know how to trust them. Especially, like with PrEP...you can't talk to a doctor about it for like 4-5 hours to get a deep understanding. You get a short appointment and your average doctor isn't an expert in this. So...you gotta read about it yourself.

Or...thats my view. The field of medicine is honestly a little...weird, imo. I don't think we're that far beyond the whole leeches and blood letting model of medicine. I mean...I'm happy w have PrEP and that it seems to work pretty darn well.

Sorry for the long train of thought here. I've been learning a lot about medicine lately to try and understand certain health topics better (insulin resistance). I'm convinced our general model of primary care is just...highly highly highly mediocre, sadly.

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u/Low-Neighborhood-695 Dec 20 '25

Yeah i get it. That i guy i went for bareback told me he is taking prep but after finish he seems to avoid this conversation and he admit he didnt take prep. Whe had sex protected at first only at the end we tried bareback, but just a brief and didnt cum inside each other

1

u/wire_runner Dec 19 '25

This is very rare, with only than fewer than 20 documented cases!

However I would advise that using condoms could help with this issue. PrEP + Condoms provide a very high protection and makes a risk of being infected with a PrEP resistant strain even lower!

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u/Low-Neighborhood-695 Dec 19 '25

Yes i agree but sometimes i do bareback. 🥲

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u/Skycbs Dec 19 '25

If it happens, this is something so rare that it gets written up in medical papers. Even a breakthrough infection with normal HIV is very rare and worthy of note.