bearbandit

There's a line in your profile (what do you mean you've not filled out your profile?) to give your name on bbrt

We need an attitude re-adjustment: the topic makes a distinction between "bare" and "safe", but it ain't necessarily so. It is unheard of for someone on meds with a VL below 200 to pass HIV on whether as top or bottom, so TasP (treatment as prevention) is a safe, bare option as is the use of PrEP. With TasP you're relying on him to be fully adherent to his meds, so TasP is really for the peace of mind of poz guys. With PrEP an HIV- guy knows how adherent he is, and if he takes his truvada every day, it's a damn sight more effective a prevention strategy than breakable condoms. Bare =/= unsafe.

Your doctor's right in that we don't know the full range of side effects yet, but it will be many years before we do (long term survivors are only now discovering the side/long term effects of earlier drugs) and other drugs will be used in preference for PrEP by that time. Things are looking good with cabotegravir from what I've heard, though it's a long way from prescription, so don't get excited about it! Surprisingly one thing discovered in the American trials and use of truvada in HIV- men is something that I've been screaming blue murder about for years: I don't care what the doctors say, but the emtricitabine component is capable of causing CNS effects, specifically it can alter dreams. Many HIV- men have reported in increase in dreaming and in trippy dreams that sound like efavirenz dreams, which has resulted in some doctors actually believing HIV+ guys about their bizarre dreams.

Thanks guys, and especially 6811283 for pulling me up on my statistical error: I got as far as sums at school and never progressed to maths. I usually avoid statistics 1) because I'm lousy at the maths involved and 2) one thing I do understand is that 1 in 1000 does not mean you can do whatever it is 999 times in complete safety. By the "law of averages" I should have died sometime in 1993, and I should have been able to take considerably more tenofovir than I did without damage. Living cannot be reduced to a set of numbers

Don't fall into the trap of thinking about odds catching up with you. The chances are the same each and every time. It's practically unheard of for a top to catch HIV from a bottom with an undetectable VL, but that's not the same as impossible, just very, very unlikely. There's a gene, the presence of which makes a person almost certain to have a life-threatening reaction to abacavir, a common ARV: it's common enough that it's automatic to check for the gene's presence. It's prevalence amongst whites of north-east European extraction is about 10%: that doesn't mean that very tenth such person to be tested for the gene at a given clinic will be found to have it, just that about 10% of all tests done for the gene will be positive...

As others have remarked, we don't know the starting point... What's normal for one person is high for another and low for a third. Also the CD4 count is a vague and wandering creature: a cigarette a few minutes before the blood is drawn can add 10% to 20% to the result. Admittedly I was pretty sick at my nadir of 80, but I was mentally and physically exhausted when my partner died and had a CD4 (my highest ever) of 880. My partner had a good way of expressing it: what's normal for you? He had naturally low blood pressure and used to have to warn medical staff taking his blood pressure of this lest he find himself being admitted to the ward. Low blood pressure was "normal for John". Increasingly, despite the US' insistence on using a CD count as part of the definition of aids (in the UK we can now say "when I had aids"), it's emerging that the important number is the viral load, which shows how well suppressed and unable to cause further damage the virus is.

"blood tests for problems"... Does this refer to the abacavir content of triumeq? If so, it's because abacavir can cause a life-threatening reaction in people who have the gene HLA*5701: it's now routine and good practice to test anyone for presence of this gene before letting them anywhere near abacavir, so it's no longer something to be alarmed about. Lamivudine has been around since the nineties: it's a well-behaved drug, very similar to the emtricitabine used in truvada. Dolutegravir is the newest of the three drugs in the combination: I've found it effective and its drug family (integrase inhibitors) have given me fewer problems than any other drug. Insomnia is the commonest problem with dolutegravir. Overall, there's nothing in the combination that would lead to raised liver enzymes, though possibly "the shock of the new" might be the reason. One, maybe two, off kilter readings I wouldn't worry about, it's only when they become persistent that there's a problem. Hope things go well for you...

If they're both undetectable, there's no problem as the bar for undetectability is around 50 and the it's reckoned to take a VL of 1000 to be mildly infectious. Have fun!

I'd definitely dilute the coffee, and I would seriously dilute alcohol: as well as getting pissed through absorption through the rectum walls, which are designed to absorb liquids, there's also the question of shock. Drinking alcohol, it gradually enters the blood stream over a fairly long period of time, whereas the arse absorbs liquids fast. Be very cautious with alcohol play: better disappointed than in casualty...

It takes a ton and more of trust and communication. I've got small hands so I've started a number of guys on the road. You must be able to communicate with the guy topping you and feel okay about basically giving him instructions. In all of kinkdom it's the occasion when it's most obvious that the bottom is the one in control, except of course when the guys doing it know each other extremely well. Done wrong, it can lead, obviously, to a lot of physical trauma but also a lot of mental trauma. Should something go wrong, get to an emergency room and be totally honest: they, like us, have seen the online x-rays of foreign objects in rectums... Done right, it's a near-spiritual experience. An intense connection...

This is the only place I've encountered numbness/pins and needles as a side effect. In instances where a drug has caused a problem that has an effect (real life example: the old dose of ritonavir caused diabetes after a long enough time and peripheral neuropathy can be a complication of diabetes), you can ascribe pretty much any effect to any drug. My regime when taking a new drug is to scan the side effects but of the leaflet briefly, concentrating on the extreme stuff just in case. Then I take the drug for a month without going over any of the leaflet again. After a month I go back to the leaflet and realise that none of those effects have happened without explanation (such as diarrhoea after eating a lot of beef: a personal oddity) and carry on for months two and three. Then, when it's more a question of intellectual curiosity do I go to the leaflet and read it all (and almost always pick up another three month's worth. One of the problems with starting PrEP is that you're in good health. You're not used to taking pills and expects to be the 1 in 1000. Sorry, but even common side effects (minor irritations) only happen to 1in10 people. Take the pills, get laid and have fun!

In actual fact the chances of getting HIV from a guy who is undetectable are so close to zero as to be negligible: undetectable is below 20 to 70 copies of virus per millilitre (the number varies according to the age of the lab equipment, so it's a local thing), whereas the lowest VL reckoned to be infectious is 1000. Yes, I know there's been a story here about someone getting HIV from a guy with a VL around 400, but until I see evidence, it's just another internet story. On the PARTNERS study, looking at serodiscordant couples, their definition of undetectable has remained at 200 because that's what undetectable was when the study started. In the rare instances of someone getting HIV on that study, there's always been a third (or fourth or fifth...) person with uncontrolled HIV involved. But all the above relies on the poz guy's adherence to his meds, which is why PrEP is such a damn good thing: it gives you control of your health. Whatever else you might catch, the can be all but certain that you won't get HIV. While the guy in Canada who got HIV while adherent to truvada was extremely unlucky, it was bound to happen sooner or later: the good news is that HIV that is resistant to both tenofovir and emtricitabine is incredibly rare: most poz guys who move off truvada do so because of the rare side-effects, which we're much more prone to than HIV- guys.

A few comments: To the original poster: seriously consider PrEP. If it's too expensive where you are, would something like this help http://www.iwantprepnow.co.uk/ As for being the "pill monitor", it's a job I've done for partners in the past and you have no idea how much I'd like someone else to take care of my medication! Taking it isn't a problem for me as the pain from neuropathy prompts me, but sorting out my pillbox every week... Before I had the prompt of pain relief to take my meds, I'd often skip several days without actually taking them: it's easily done, and a "pill monitor" can help enormously. BBNudistBoyWhore: there is no science behind what you're saying and you can only speak for your own experience. For the vast majority of people with HIV, the drugs are vital if they want to remain healthy. HIV has a long latency period between fuck flu (if indeed you ever have it: some don't) and illness becoming apparent. For myself it was nine years between seroconversion illness and the appearance of HIV related symptoms. The START trial demonstrated that people who start ARVs immediately on diagnosis have better outcomes than those who wait till a pre-determined CD4 count. hungry_hole: you're right about the rarity of a zero viral load. It's something I've managed twice in the past five years (I'm more closely monitored than most because I'm on salvage therapy). However, as you know, it simply means that no HIV particles were seen in that sample, and that HIV is still hiding...

As close to zero as you can get. Even if one or more guys had cum or pre-cum on their fingers, the likelihood of it being from someone with a high viral load is pretty remote: even though about a quarter of guys with HIV don't know they have it and thus are more likely to have a higher viral load, guys on treatment with a detectable viral load are very much in the minority. Next we've got the question of quantity: even with a full load of high viral load cum, the transmission chances are just over 1%. We're talking about a virus that's actually pretty difficult to catch. Personally I don't think you have anything to worry about at all. As regards PrEP, if you can't wait for the shameful mess in the UK to be sorted out, go to http://www.iwantprepnow.co.uk/for information on importing your own generic truvada for about forty-five quid a month.

It's just possible that his last test was negative - being poz doesn't automatically turn you into a liar . But assuming he's poz and has a high viral load, then even without PrEP, your chances of infection are considerably less than 1.4% which is the rate for having someone with a high VL cum in your ass. However, the four days you'd already taken truvada for, it strikes me, would be equivalent to the event-based dosing that some European studies propose (a double dose two hours beforehand and one at 24 hours and another at 48 hours). Yes, what you did falls outside of the maximum protection bellcurve; hell, one poor guy seroconverted despite being completely adherent, which is why you never claim anything in medicine is 100%. Although the doctors drum it into you "never miss a dose", that along with "seven days to maximum protection" can be taken with a dose of salt. For people with HIV the doctors are happy if you're 95% adherent, which suggests that the drugs are effective at a lower adherence rate, though I wouldn't like to experiment to find out... In real life terms, you've run across a road without looking properly, but you're still here to write about it. What happened falls outside of the doctors' idea of what's safe, but they're considerably more cautious than the rest of us. Don't double dose: what happened wasn't risky enough for that - in the UK if the prescribing doctor thinks the risk that's been taken isn't high enough truvada only (no supporting drug from another class) will be prescribed for PEP. Instead, use this as a lesson: if, for any reason you have a break from truvada, wait the full seven days before letting yourself get into anything sexual. To be honest, I think you've done yourself more harm by stressing over the incident... Just keep taking the pills!

Talk to the guys at http://www.iwantprepnow.co.uk/. But the basic run-down is that there's not been an instance yet of anyone getting anything but the genuine article as proven by testing of drug levels in the blood. They're working on a list of clinics who are prepared to do the HIV, liver and kidney testing as tart of a standard STI checkup. My personal thought is that they should be treating use of tenvir-em the same as they treat any other drug use: non-judgementally and with an eye to making sure that it's as safe as possible, which obviously would mean doing all the tests. It should be noted that many GUM clinics are outraged by the decision not to provide truvada as PrEP, because expensive as "the real thing truvada" is, it's way cheaper than a lifetime's worth of HIV treatment. The guys at http://www.iwantprepnow.co.uk/are very down to earth, and there's nothing you can tell them they haven't heard before or done themselves. You don't say whereabouts you are in the UK, so it may be that you'd need to travel: it's not unknown for people with HIV to travel a couple of hundred miles to get our treatment, largely because we've learned to be picky. Best of luck!

The prescription sounds good - hope you've taken your first dose by the time you see this. Even in the short term, the side effect profile while your body gets used to these strange new chemicals you're making it process is pretty good. I honestly wouldn't expect any more than feeling a bit "iffy" for a few days, as though you're coming down with the current thing that's doing the rounds (at the supermarket - not the bars!). Hope you fall into the bracket that has no problems at all, which is most people... As regards your colleague, I decided long ago that knowledge of my HIV status was very value, so I destroyed its value by making it common knowledge. Not everyone can do that, but do remember that she's bound by a code of ethics to observe your confidentiality, just as you're expected not to gossip about your patients... One word about dolutegravir: don't take mineral supplements within six hours of dolutegravir... The reason is that the molecules of the supplements get tangled with (well, that's how it was explained to me!) the dolutegravir molecules making less dolutegravir available in your blood. Ordinary food is fine, but calcium/vitamin D as given for osteoporosis, for example is definitely one to take later/earlier...

I had possibly the most severe reaction possible to tenofovir, which happens to around 1 in 100,000 people with HIV; there's every reason to think that the only side effect of truvada commoner in guys using it for PrEP rather than treatment is the dreams issue, which is caused by emtricitabine. I had damage severe enough to my kidneys that I was pissing away vitamins and minerals rather than recycling them (Fanconi's syndrome): the very least of my problems was having to remove my PA because I couldn't deal with the calcium buildup on it. Among the minerals I was severely deficient in was potassium, which is responsible for regulating the heartbeat and for rational thinking as the firing of neurons depends on a sodium/potassium interchange. I was, I've since discovered, going to be sectioned under the Mental Health Act if I refused to go into hospital so severe was my illness and its accompanying irrational thinking. I also developed osteopenia due to my inability to retain calcium. I now have prescribed a wide range of minerals and vitamins to replace what I piss away. Please remember that this illness/reaction to tenofovir was exacerbated by having an incompetent doctor who didn't pay attention to my blood results, and that Fanconi's syndrome is extremely rare: I'm aware of literally a handful people in the UK who started down the road towards Fanconi's but who had more competent doctors than I did. To have it as severely as I did lead to me being the "show and tell" of the year for my consultant... I drank heavily up till the beginning of last year but neither component of truvada gave me any problem when combined with alcohol. Truvada, or rather the tenofovir component, is known to cause some gastric upset: bloating discomfort and IBS-like symptoms are not unknown, but can be partially at least resolved by taking truvada with food (or if that upsets your guts, on an empty stomach): for absorption purposes it isn't dependent on food, so whichever works best for you. If you have gastric problems with it, cutting back on fat, especially animal fats, I'm afraid, can help, as can yogurt containing lactobacillus bacteria.

Please no! Men cannot "get by" on just twice a week: that would lead to blood levels sufficiently low that protection would be inadequate. The IPERGAY study (event based dosing: two beforehand, then one afterwards and another 24 hours after that) has shown similar results, but it's probably good practice to go the full course as in the USA PrEP guidelines. Cis-women need 21 days before the full protective effect is there and there isn't sufficient information for pre-downstairs-op transmen who use their vaginas for sex. If you're considering a break from truvada to see if it's the cause of the problem (possible, but unlikely, in my lay opinion) at least seven days after your last possible exposure and then if the break is longer than two or three days (the time it takes for the drugs to leave your system), you'll need to do the full seven day loading again before taking loads. The symptoms you describe are all fairly vague and some are definitely associated with hypertension and its regulation. I hate to say this, but it could also be simply age, or even depression. A few people have noted a decreased tolerance for (and enjoyment of) alcohol while taking truvada, but that's pretty unusual. As far as the weight gain goes, it's another possible but unlikely, but weight gain could account for an awful lot of the rest, especially if you don't feel happy about it. Hope you get things sorted...

The chance of getting a new strain of HIV while you're on treatment is pretty damn remote: three drugs to mutate against and that 1.4% chance of infection (since it would be as though the bottom wasn't taking ARVs at all with the top's virus resistant to all of the bottom's drugs. It's reckoned that the number of time re-infection or super-infection (same thing really) happens per year can be counted on the fingers of one hand, with a couple of digits to spare. My personal take on this is that especially around the time of diagnosis many poz guys find themselves not so much a human being as a walking infection, paranoid about every little splash of piss, trickle of saliva and so on. We know intellectually that that's nonsense, but tell that to your gut. When I was first diagnosed it took me about a year to stop carrying around sticking plasters "in case of a cut" everywhere I went. It's not uncommon for men to lose their libido after being diagnosed: sex is too much of a risk. Why do so many men feel like this? Because the media tells them to. Because you can casually mention that fact that you're poz in a bar and see the guy you're talking to mentally taking three steps back away from you. Another reason can be that a guy looks at the crap he's put up with because of HIV and really does not want to be the cause of someone else going through something similar. I broke a promise to myself in that I was only ever going to get involved with poz guys in future. Then I met a neg-at-last-test guy... Although my general health is pretty lousy one thing I do know is that my HIV numbers are all the right way round, so I have no problems sticking a hand in his butt or him fucking me. I work on the rule that the most cautious guy involved sets the limits. Frankly I'd rather use toys than a condom, which, when he's hot enough is what happens if his risk assessment tells him he needs condoms. The guy who wanted a condom for a blowjob got a lecture in HIV transmission (he was working on information from 1991 - he actually remembered the date when he'd heard the advice), and shown to the front door: just because his risk assessment is "tighter" than mine doesn't mean that I still have to have sex with him. And even though I'm pretty non-infectious with a recent viral load of 40 or so, and even though I know any virus in my cum is not going to be anywhere near enough to establish an infection in someone else, I'm uneasy with that risk. For me pozzing someone is strictly for roleplay. Almost all the keeping sex as safe as possible, keeping risks within your limits have been aimed at HIV- men, to encourage them to stay that way. There's very little for poz men, even though we have limits too. If your risk assessment and his risk assessment coincide - great: go fuck. If there are serious differences, discuss them if appropriate but don't ever end up doing something that makes you feel uncomfortable or force your ideas on to someone else. Remember, it's about having fun...

<breaking my own damn rules> To the best of my knowledge (gathered from several sources: you'll have to trust me for their accuracy as I will not go any further into breaking confidentiality) the other guy doesn't know or isn't saying he's poz. Leaving all personalities out of this, we've known all along that something like this would happen sooner or later: nothing in medicine is 100% except for eventual death. Everybody's slightly different from each other, so much so that we can't even agree on what a "normal" blood pressure is, but express it as a range instead. My partner had such low blood pressure naturally that he had to warn medics before they took his blood pressure that they'd find it abnormally low, but that was normal for him and no, he didn't need to be admitted: he was at the far end of the bell-curve for that particular test. Even a negative HIV test only means that no indication of HIV infection was found on this occasion. I've had viral load tests come back as zero, meaning that no viral particles were observed in my blood. I was right at one end of the bell curve the twice that happened to me. Sooner or later it was inevitable that someone taking PrEP would be infected with a mutation of HIV that's resistant to tenofovir and emtricitabine, which is why the search is on for the next drug, and the next and so on, just as the search is on for new treatments for HIV disease. The surprise has come in that it's happened relatively quickly: it's only human when something has only a very small chance of happening to expect it to take a long time to happen. A mistaken thought process because given the same circumstances the odds of event *A* happening under circumstances *B* are exactly the same each time event *A* happens under circumstances *B*. Look at guys wanting to get pozzed: some try for years, even decades, whereas others have barely taken the decision before they're popping their first atripla. I was nearly killed by tenofovir, but I recognise that there were a number of circumstances contributing to my situation taking the odds of the combination to well over 1 in 1,000,000: I have no difficulty in urging HIV- men to take PrEP and for poz men to use truvada because what happened to me was such an extremely rare set of circumstances, that the risk of it happening to someone else is outweighed millions to one by the benefits of taking the drug. To sit and dwell on the possibility of it happening to someone else would be like refusing to leave the house for fear of traffic accidents (which are way commoner).

I've been aware of "Joe" since he seroconverted: his story hasn't changed in any respect since he seroconverted. He was indeed on truvada as Canadian law allows for "off-label" prescription - drugs used for another purpose than their stated purpose. And that's all I'm going to say about him: I can't even remember his real name now. As to why more haven't got HIV from the other guy, as fillmyholeftl said, maybe he just doesn't get around that much. Plus, of course, there's the fact that HIV is pretty hard to catch - it averages out at a 1.4% chance per fuck. And just because you're not on treatment doesn't mean that you've automatically got a high VL: I've got multiple resistances and in 2007 took a drug holiday after my partner died. After seven months my VL was only 65k. I say "only" because others have gone way higher than that, and others have stayed in four figures. For reference sake 1k is reckoned to be the lowest infectious point; the fuss about being undetectable is (a) belt'n'braces protection for the HIV- guy and ( health protection for the poz guy as HIV causes damage to the body even at extremely low levels. It's simply a question of trying to minimise the damage.

More on this at http://www.thebodypro.com/content/77164/hiv-infection-despite-prep-6-things-providers-and-.html I believe that truvada-as-PrEP has been available off-label in Canada for a while. It's also possible that the guy concerned was importing his own generic TDF/FTC (Tenvir-Em or similar) with the support of his doctor. This is the first and ONLY documented incidence of failure of adherent truvada use to prevent HIV infection. As indicated by the article I've linked to, the mutation is very rare, and the HIV+ guy must have had a fairly high viral load to be infectious at all (remember that even with a VL above infectious levels, the chance of transmission is still only 1.4% - HIV remains very difficult to catch). There probably have been a few, and I mean a few as in three or four at most, other seroconversions in guys using truvada, but these haven't been documented in such meticulous detail as this one: the others remain, for scientific purposes, undocumented, essentially hearsay or garden-fence gossip. More than the 9,200 trial participants: add in the participants in trials other parts of the world (not everything happens in the USA!), everybody taking truvada-as-PrEP officially (tens of thousands in the USA alone), and everybody who's making their own private arrangements to import generic truvada. In the UK we (PrEP activists) know of 16 clinics who are prepared to do the necessary bloodwork for people who are importing generic truvada and the call has just gone out to get people to ask if their STI clinic would help out. The fact that this guy is now doing well on ARVs is proof that even with resistances to drugs, there are all but certainly other drugs that can replace the ones the mutated virus is resistant to. Indeed if that weren't the case, I wouldn't be typing this as I'm resistant or allergic to practically everything in the pharmacy: indeed by coincidence my prescription is very similar to the Toronto guy's. Basically, what I'm trying to do here is put this story into context: if you're taking or considering PrEP, please carry on/go ahead and don't worry about it: you're more likely to be in a multi-vehicle pile-up and get struck by lightning than have PrEP fail in this manner.

Historically only alkyl nitrites have been referred to as poppers (so named because the used to be supplied in small glass containers that you "popped" or snapped and inhaled to fend off an angina attack. Calling ethyl chloride poppers is a new one on me...

The reason for "official" efficacy of PrEP not being 100% is that it's all from the trials. Someone who starts a trial, drops out and seroconverts still has to be counted in at the end of the trial, presumably because one of the things they're looking at in the trial is how adherent people are going to be to the trial protocols. Also, there have been a few instances where someone went to start the trial and was in the first few days of infection when none of the tests will pick up HIV, and though they dropped out of the trial (truvada alone is not a complete treatment for HIV - you need at least one other drug in the mix to treat HIV) but were still counted in the final reckoning because they'd started. Put to the test properly, in the field, as it were, news in coming in from various projects that they have experienced no HIV infections in their users. The one that most readily comes to mind is a project in San Francisco which reported a zero infection rate in an entire year of dispensing truvada as PrEP, doing the appropriate blood tests etc. Basically the experience of PrEP in real life as opposed to the strict trial rules is that it's as close to 100% as it's possible to get. Yes, it's quite possible that out there somewhere is a guy whose HIV has mutated to be resistant to both tenofovir and emtricitabine (note that both drugs require rare mutations in HIV for them to become ineffective), but he's very likely to be on a different combination which is successfully suppressing his virus, which is where TasP (Treatment as Protection) comes in: it takes a viral load of about 1,000 parts of HIV per millilitre of bloodto be considered mildly infectious and therapy regards undetectable as between 20 and 70 parts per millilitre - I've had the consultant demanding extra bloods and tests because of a rise in my viral load to 130... Most guys stop tenofovir and/or emtricitabine because of the side effects, which are more severe in people with HIV than they are in HIV- men using truvada as PrEP.