bearbandit

The danger with using alcohol of any strength for an enema is not the level of intoxication that will result, but the possibility of shock. When drunk, alcohol is absorbed slowly into the system. When used as an enema it is absorbed directly into the bloodstream and it's entirely possible that someone's system will not be able to handle that level of I intoxication so quickly. As for HIV prevention, PrEP is the best solution, followed by importing your own generic truvada, followed by clinic hopping (claiming to barbarism sex and needing PEP). A wine enema isn't going to make any significant difference.

That's because rank is dependent on the number of posts you've made. Off the top of my head your rank changes after 25, 100, 500 and 1000 posts.

Thank you, as ever, fillmyholeftl, for the correction. Personal shit is taking up more time than I would like, leaving less time to keep ahead of the HIV news... My apologies for misinformation.

From what I understand there's far less documentation in this instance than in the other two, and I don't think anything is known about his adherence. There's a difference between extremely unlikely and impossible. But there's a whole load of rare events (like getting struck by lightning) that are more likely than seroconverting whilst being adherent to PrEP.

If it ain't broke, don't fix it! If he's undetectable, then the meds are working. Everybody's different in how they respond to meds, but I have to admit I've never heard of anyone going 20 years without a change in prescription. It might be an idea for him to talk to his HIV doctor about the possibility of changing, but if he's undetectable, he won't have enough of a viral load to test to see what would be the best combination for him (you need at least VL 1k and undetectable is between<20 and <70 depending on the lab). Also, if he's been on the same meds for so long they obviously must be fitting in well with his genetics so that he's having few in any side effects. There's no way of telling how long the same meds will continue to work for him: prediction and medicine do not make good bedfellows

From what I've read about this, the guy's virus has two specific mutations which make it resistant (but not totally resistant) to tenofovir. I've seen the list of drugs his virus is resistant to and it's about 10 (mostly, if not all, NRTIs and NNRTIs). Once analysed, we know which mutations will make HIV resistant to which drugs,so it's not a question of Gilead pulling their fingers out. It's important to remember that resistant/mutated virus is weaker than wildtype virus, and ultimately mutated virus is overtaken by wildtype virus, which is how come resistance fades over time and drugs can be re-used. While it's always been known that getting assfucked bare is the commonest infection route, it's always been known that the guy fucking can get it: how else do hundred percent hetero guys get it sexually from women? For this to happen twice in a year is still within the expected efficacy of truvada as PrEP. While on an individual level of course it's a bloody disaster, but on a total population level, it's unsurprising and truvada is as near to total protection as you can get. If I were neg and on PrEP I wouldn't be worried on a personal level: all manner of things are still more likely than seroconverting while on PrEP. apologies for any typos - writing this in bed and my tablet's dictionary isn't as versatile as the PC's...

AHF have persistently campaigned against PrEP: remember Weinstein calling it a "party drug"? I wouldn't trust anything that AHF has to say about PrEP (and am very glad that they're not a UK organisation!). What they keep failing to realise is that PrEP is part of an overall package towards curbing HIV transmission, and banging on about other STIs is a red herring. PrEP is designed to protect against one STI, namely HIV, and has no effect on other STIs. As rawfuckr mentions guys on PrEP are screened for STIs more frequently than most of the population, and if you look for things, you're liable to find them. It's perfectly possible to have an STI with no symptoms whatsoever, yet still be infectious. Gonorrhoea, for example doesn't necessarily present with a dripping cock: if the infection is in your ass, or your throat, it can be quite easily (if symptomatic) be dismissed as a bout of diarrhoea or a sore throat from "the bug that's going around". For all the importance that some people, and yes, AHF are amongst them, condoms don't necessarily protect against STIs: herpes, syphilis and others can easily be passed on by touch. If you can get PrEP, great. But even if you decide against PrEP, or it isn't available where you live, have regular STI checkups. Your fuckbuddies will thank you.

Thanks for the clarification there: I was meaning the sort of bone loss that constitutes osteopenia.

A regular STI check-up every three months, whether you're showing symptoms or not (about half the time men have no symptoms of an STI that they notice). More frequently if you're popular. And get vaccinated against Hepatitis A and B and HPV. As fillmyholeftl says, it's chance... I've only had three STIs in my life: hepatitis B, herpes and HIV.

Side effects of truvada are much commoner in people using it for treatment than prevention, except in one area: a few people find that their dreams can be somewhat intense. It's rare enough in poz people that my doctors insisted that the FTC (emtricitabine) in truvada couldn't possibly be the cause. Basically it was people on truvada-as-PrEP who convinced the doctors that this was real. Go figure! Apart from odd dreams (which only happens to a few) the commonest side effects are felt in the gut: a bit of nausea maybe, gas and loose stool, not enough to call diarrhoea. But most people get away with nothing at all. The thing to do is to experiment with the time of day you take it, with or without food, until you find out when your body's happy about it. But most people, probably 80% to 95% get away with no problems at all. If you do have problems try and work through them as they pass after a few weeks. The other problem with truvada is that the tenofovir can, in a very few people, cause a slight loss of bone tissue, but this is completely reversible simply by stopping taking the drug. About 1 in 10,000 poz people (a guess given my involvement in long term survivor groups, and that Fanconi's syndrome, a symptom of which is severe weakening of the bones occurs in about 1 in 100,000 poz people) will develop significant enough bone loss to require supplements, but this just hasn't been seen in HIV- people. Don't worry about long term use: the history of PrEP is six or more years old, which is a bloody long time in HIV terms, including all the trials and truvada is incredibly well tolerated. And within in a few years there's very likely to be another drug replacing truvada, I'm guessing cabotegravir, which from all my reading seems to be very promising. It's the drug that they're talking of being an injectable, so if it's approved for PrEP, it may be once a month or even once a quarter your get your PrEP injection. Don't worry: take the blue pill!

Thanks PozGoat - you've made my day. I know I'm apparently not around as much as I used to be, but that's because there's less need to intervene or comment. I don't drink alcohol or coffee, so I guess it'll have to be the cum

If he was poz, he's very likely to have been on successful treatment: recent trial results show that people with HIV who have an undetectable viral load (the goal of current therapy) are not infectious. End of worry. If he was poz and not on treatment, then his viral load could have been anywhere from a few thousand (about a thousand is the minimum viral load generally considered to be an infection risk, though there have been anecdotal reports of lower) to very high: depends on what stage of infection he was at. But generally I'd say this was pretty low risk. The tone of your messages suggests that you're very panicked about this and for that reason I'd suggest you go to an emergency room now and get medical advice. For there to have been any risk he'd have had to be poz and not on treatment, and you'd have noticed the pain when he rubbed the cum into your chest: cuts hurt when they're disturbed like that. But I have the feeling that you're not going to be satisfied with less than a medical opinion, which you can get, together with PEP (post exposure prophylaxis) from an emergency room. Note that PEP is only useful within 72 hours maximum, and better within 48 hours of the incident. While you're at the emergency room, I'd suggest that you ask about PrEP (pre-exposure prophylaxis) which, when taken properly will avoid all this panic. Finally, I ask you not to post essentially the same question in more than one forum: all it does is make you feel like you're doing more, but it irritates other people to the point where they're less likely to respond to you. Now, get yourself to a doctor...

Casual antibiotic use is a great way of ensuring that bacteria get practice in at becoming resistance to antibiotics. Truvada as PrEP works by ensuring that any HIV encountered is totally eliminated before it has a chance to establish an infection. Different bacteria are susceptible to different antibiotics. I once took six different antibiotics on holiday to the USA (during the HIV+ ban), each labelled with the symptoms of the disease they were to treat. an unsatisfactory approach, but the only viable one at the time. Regular STI check-ups and treatment when appropriate remain the best way to deal with STIs other than HIV (prophylaxis) Hep A/B and HPV (vaccination).

In the late 70s, pre-aids, I worked at London Gay Switchboard. Our health advice still stands today: many STIs don't necessarily show any symptoms, especially in the ass or the throat, and if they do show symptoms they can be ambiguous. So get checked regularly: the STI clinic is your friend. We used to recommend every three months, or more frequently if you're popular, or feel there's been a specific risk.

Certainly when the PARTNER study began their definition of undetectable VL was <200, which was the usual treatment definition. As improvements were made to analysis of blood samples, the definition dropped to between 20 and 70 (depending on where you are in the UK), with the commonest threshhold being 50. I don't know if the PARTNER study moved the goalposts in accordance with clinical improvements (I've was on the nevirapine where the protocols were re-written to allow for the use of the newly released protease inhibitors). Whether or not the PARTNER protocols were altered, this, together with the START study (don't wait for CD4 levels to drop: start immediately), are what we've felt in our guts for some time and our feelings are now vindicated.

The "chem stories" for sale posts should no longer be visible...

I know of a number of British guys who've picked up hep C a second, or even a third time. Medical ethics dictate that someone re-presenting with hep C should have exactly the same non-judgmental attitude from medical staff as anyone else. With the price of the new hep C treatments being as high as they are, I guess it's possible that someone re-presenting could be put onto one of the old more difficult regimes. It's worth noting that in the UK if you need a liver transplant because of alcohol related damage they generally require you to show three months minimum abstinence from alcohol before you can go on the waiting list. It's generally rare for hep C to be transmitted sexually as it requires a degree of blood to blood contact. Most likely scenario is cross-contamination at fisting parties where tops don't wash hands and arms before plunging into a new hole, though of course it doesn't have to be fisting, just that fisting offers the easiest route. May I wish you the best of luck with the treatment, and could I ask you to keep us updated on your progress... Knowledge is power...

HIV can "piggyback" on other STIs, hence the need for STI testing (and more than 50% of gay men don't notice any symptoms of an STI when they have one). Although it's unusual for liver/kidney function to be affected in HIV- men on truvada, the protocol does demand quarterly testing along with the STI/HIV testing to be sure. Some men show a non-significant loss of bone density (which shows up in the kidney testing). Although truvada as PrEP has been tested very thoroughly, it's important not to lose sight of the fact that it's in its infancy, even after four years of being an approved regimen. The side-effects of truvada are much more evident in HIV+ men (except, curiously, for the weird dreams caused by the emtricitabine): I hit the long-shot with Fanconi's syndrome which brought me to within days of death. Although we're pretty confident that HIV- men show far fewer side-effects than poz men, is it worth taking the chance?

My huge biohazard tattoo is there more because I want to start discussion about HIV and show that I'm not ashamed to be poz (it is, after all, still visible when I'm fully dressed) than it is because I'm a "dirty bastard who lies in order to breed guys". Unless he told you that himself, you haven't really got any reason to think it.

It's funny, you know... We have very tight gun control in the UK and though I knew several guys who died at the hands of a murderer, none of them was killed with a gun. Yes, we've had mass shootings (one of them happened in the town I was brought up in) but they've happened with years, not days, between them. Just a thought...

If you're old enough to fuck you're old enough to get yourself screened every three months for STIs (more often if you're popular). Don't wait for symptoms: over 50% of the time you don't have any symptoms. STIs can do a lot of damage to your system if left untreated and HIV isn't the only STI that can kill left untreated.

moderately frequently?

Actually, PrEP is a damn sight more effective than condoms, providing, of course, that you take the pills as per prescription. With the "real world" figure for its success rate, only one person ever has seroconverted while taking truvada as PrEP as prescribed. The 96% efficacy rate comes about because in a medical trial you have to include everyone within the trial, whether they complete it or not. A few seroconversions while taking truvada were in people who'd been infected just days before being tested for a PrEP trial - they count towards the final result. And in a number of instances in the PROUD (UK) trial there was not a trace of either component of either drug in truvada to be found in their blood samples, meaning that they hadn't been taking the pills at all, but they still count to the end result. Condoms work 96% of the time when they're used properly. Too little lube, too much lube, the wrong size... all lead to a real world condom success rate of about 86%. The PrEPFacts group is mixed gender, gender expression and sexuality: if you join it you may recognise a few faces from here, though of course I'm the first poster in this thread with a FB friendly profile pic

I'd push for three monthly monitoring as that's what the PrEP protocol recommends, for a start. Change doctors if necessary. The one seroconversion that's happened was inevitable statistically: it just happened sooner than most people thought it would. Apparently the dual resistant strain of HIV has mutated at one point along its RNA: the site has been mapped and is included in resistance tests that PwHIV have. The spanner in the works is that it needs a VL of 1000 (last I heard: if someone else knows differently, reference please!) to do a resistance test. The good news is that mutated virus is weaker virus so eventually resistant virus returns to wild-type, which is why some drugs can be re-used after a layoff of a few years. If you were unlucky enough to get the mutated virus (and I'll leave out lottery number comparisons), all that would happen is that for a while you'd be receiving substandard medication. Remember that not all the virus in the load that infected you would be mutated, only an unknown proportion of it, and the unmutated virus would still be susceptible to truvada. However truvada alone isn't an adequate treatment: you need at least one more drug from another class (both drugs in truvada are NRTIs - nucleoside reverse transcriptor inhibitors, reverse transcriptase being an enzyme HIV needs to reproduce). Basically, you'd be in the position of someone with HIV before the discovery of protease inhibitors and the development of combination therapy: some therapy but not enough. However, come your next appointment and the positive test result you'd be on full therapy before you had a chance to sit down. Dual therapy with truvada isn't by any means the best we can do today, but it's still better than nothing. Because of the state of knowledge and how the epidemic unfolded I went nine years without any therapy, and a further seven with therapies now proven to be inadequate in the extreme. Even with the worst immune response imaginable to HIV and no treatment whatsoever, you'd live more than a couple of years: my partner who, died in 1992, was a virgin until 1983 when he discovered a leatherbar... Basically, just make sure that you keep taking the pills, don't worry and enjoy yourself! <edit on seeing rawfuckr's post> Obviously the medication offered is unlikely include truvada, but it is possible. As I understand it, last I heard of the guy in Canada is that he's using truvada along with other drugs. In other cases of people seroconverting on PrEP there's either been a degree of non-adherence or else the person concerned was in the very early stages of infection (and therefore the virus not found by testing) when starting PrEP.

A short course of one of the "z" drugs (zopiclone or zolpidem) might help with re-establishing a normal sleep pattern. Doctors don't usually like prescribing them as they're supposed to be addictive. They work by putting you into a state where you're more inclined to fall asleep (hypnotic) and wear off after a few hours, leaving you in a natural sleep. One warning I would give about them (and this is from experience!) would be to keep them somewhere other than the bedroom, maybe even mark on the packet when you take them, because it's very easy to forget you've taken the pill and accidentally double up.