bearbandit

I'm not stalking you, but you keep saying things I agree with... From my perspective there are only two HIV statuses: Poz and "unknown"

You're quite right - my mistake entirely as I was thinking "Atripla". My excuse is that I sometimes get confused between pharmaceutical names and "public" names. I'd simply forgotten the name Sustiva as I always refer to it (as to most in the UK as efavirenz. My apologies for the confusion. It's getting more and more common to genotype before prescribing in the UK. Important to note that genotyping requires a viral load of at least 1000, so that when I blipped last year and became briefly detectable, there was nothing to be done except carry on as before and genotype should my VL get to 1000. That's when it went down to 0. For some time now the view in the UK has been "ok, go ahead, but just don't shout about it". The official position is still that neither PrEP nor TasP are sufficient. The final weapon they use is "but what about all those other STIs that condoms protect against?" In the seventies it was standard advice that if you were sexually active then you should have a checkup at least every three months. It was as much a part of gay life as the risk of getting arrested for looking at another guy's dick in a public toilet. What's been noted in the UK is clusters of resistant virus, where, as I think you correctly theorise, someone has picked up HIV from someone with a drug resistance, and then that resistant virus has been passed around. Calm down? Who's annoyed? I'm comfortable with my long and varied drug career: just a little cagey about what the next step is should the current combination fail. I think too much emphasis (despite what I say about tenofovir - I'm allowed a little hypocrisy surely) is placed on side effects, though you're right about different people reacting differently. When ritonavir was first introduced a friend got such bad pain from it that he was prescribed morphine. I just got diabetes: know which I'd rather have had Tolerance of abacavir varies. This from Wikipedia: "There is an association between the prevalence of HLA-B*5701 (my words: the gene responsible for abacavir sensitivity) and ancestry. The prevalence of the allele is estimated to be 3.4 to 5.8% on average in populations of European ancestry, 17.6% in Indian Americans, 3.0% in Hispanic Americans, and 1.2% in Chinese Americans. There is significant variability in the prevalence of HLA-B*5701 among African populations. In African Americans, the prevalence is estimated to be 1.0% on average, 0% in the Yoruba from Nigeria, 3.3% in the Luhya from Kenya, and 13.6% in the Masai from Kenya, although the average values are derived from highly variable frequencies within sample groups." For the past ten years it has been pretty much automatic to test for HLA-B*5701 before prescribing abacavir. I sat in the doctor's office in 2004/5 while he decided he might as well order a genetic assay before changing my combination. Just as well he did... One TMI deserves another

You're absolutely right: maintaining an undetectable viral load means taking care with the drugs, regular monitoring and STI checking. I'm on quarterly appointments and my last two viral loads have been 0 (that's a number, not a euphemism). I couldn't give someone HIV even if I wanted to. The guys most likely to have HIV are the ones who rely on (I don't like even repeating the terms) "DDF" and "Clean U B 2". How long is it since they've seen the inside of an STI clinic? I know a guy who regularly takes it raw, but only tests once a year... In the UK it's reckoned from anonymous blood sampling (syphoning off a little bit of blood when someone has a blood test for something else, and put into and unlabelled tube) that 26% of people with HIV don't know they have it. Sorry to go off on a tangent from your question, but it's a soapbox thing: the way forward in stopping HIV is treatment as protection (TasP) and PrEP, which, of course, implies test and treat, meaning regular testing (which you get with PrEP anyway...

Not quite: it contains the original formulation of tenofovir, not the new formulation. The new formulation (due to be released soon, if it's not already available) has a lower side effect profile and will be incorporated into existing combination drugs.

Absolutely!

Like others, I think you still need to put some more thought into bb'ing. When you decide and the decision is "go for it" get assessed for PrEP. I have diabetes 2 which I manage with diet and gliclazide (which means I'll probably become insulin dependent at some point). Neither of the drugs in truvada affect the pancreas. Were you to bb without PrEP and pick up HIV there are drugs that affect the pancreas that you'll need to avoid, primarily the PI booster ritonavir (in the UK it's standard to up the dose of the PI ritonavir is boosting for people with diabetes). Should you have such bad luck as to pick up HIV it is manageable alongside diabetes, but first, I'd stick with condoms while giving bb a lot more thought.

I always reckon you should set a number of days that you're prepared to put up with side effects of a new drug. If they go on past that date, back to your doctor. I've always been on protease inhibitors (which are notorious for their effect on the gut) when at the same time as truvada, but I understand from friends on a PI-sparing regime that truvada isn't that bad once you get used to it. Say, give it a month... I'm on a three-class combination at present, including a PI. I also take a fair amount of codeine to relieve the pain of neuropathy. My consultant asked me how I coped with the constipation that the codeine causes. I replied "it's a luxury..."

I'm back to the the 400-500 range now and it's taken nearly seven years to get this far - the 880 happened just before my partner died: I didn't feel up to being fully adherent so I thought it safer to come off all meds than take them haphazardly. Nowadays I'd visit a friend every day to make sure they took they took their drugs properly: complete adherence really is that important.

Interesting, but I'm not holding my breath. I've seen far too many "cures" in the past thirty or so years. Wonderful if they, erm, pull it off, but this is just the first step down this road. Be aware of it, check it out every now out then for changed content, but it's way too early to get excited yet.

Hate to tell you this but the sentence about CD4 1140 has inserted itself from another post - my zenith reading on CD4 remains at 880, which is still 11x my nadir. I'm apparently taking credit for someone else's CD4 (If I quote I tend to italicise and bold). Sorry - just me being pedantic...

Yep, with you on that one. If that's the case then I've got a number of strokers that can do just that. Similarly if I'm in a bottom mood, I've got plenty things to sit on. Who needs men? Well, I do for one. It's about interaction, about making him feel that he's the only man (or they're the only men) in the world that matters, whether you're topping or bottoming (or somewhere else inside the pack if we're talking a group situation). The guy I'm after isn't necessarily the best looking guy there, but he's got something about him that makes want to get up there or else spread 'em. I always work on the principle that the first time's going to be pretty much of a disaster. He's only the perfect fuck in a porno. Sex is something you learn to do. How do you learn that that's precisely the way I like to be rimmed? Or that's precisely the way I want your ass muscles squeezing my dick? Practice, that's how. I don't have anything against the quick handjob in the bushes - it's just that I like a more practised approach. The quick wank can have its appeal, especially when it's somewhere you might get interrupted. Two things I never say: "I'm only here for you to use." And "I don't give a stuff about how much you enjoy it". Firstly, yeah right, if you're a good fuck, can make me piss or cum with touching myself, I need you, and secondly I care very much if you get off or not. It's not as though you're going to come back for more an encore if it doesn't work the first time, is it? If you're good, I want you back, maybe pass you around my friends or all have you together. "Don't give a stuff how much you enjoy it..." Of course it's important! Again, it's appreciation of the other(s). You pulled me into this circle and I wanted you primarily, but your friends as well. Again, we've got the thing of not knowing each other's tastes, so we learn as we go along. Could be I'll end up with someone else entirely. It's about each pleasing the other, not about "you do realise I'll walk out of your life in the morning" or"as soon as I can I'll be through the door". That's for porn stories (and offers a good way of getting a particular sex act into the story while getting rid of the character(s) involved out...

A couple of extra points: truvada may be off label in Canada but it is still esssential to have bloods done at least quarterly, firstly to make sure that the drugs are still working and secondly to make sure that it's (specifically tenofovir) not attacking the kidneys, which, believe me, is unpleasant in the extreme, leaving you open to osteopenia (fragile bones), irregular heart rhythm and distorted thinking/hallucinations. I can still remember clearly details of hallucinations I had: I know they were hallucinations, yet I cannot remove the feeling that they actually happened. As rawTOP says, there's always the risk of getting fucked by someone whose strain of HIV is tenofovir- or FTC-resistant. Pretty unlikely given how difficult it is to get HIV in the first place, but a possibility nevertheless. and again there's the risk of other STIs: it's long been recognised that syphilis makes HIV transmission easier. Other STIs are also gaining in resistance, especially gonorrhoea. Finally, as Wood implies, a guy whose VL is undetectable (ie not just on treatment) is a damn sight less likely to be infectious than someone who has never bothered testing or who leaves long gaps between tests. It's reckoned in the UK that something like 22% of people with HIV don't know they have it. Something you haven't mentioned is that if you want to live up to your name, every guy after the first in your ass is running the risk of picking up HIV - how do you think men get HIV from women? Just be careful who Daddy picks out for you...

I've replied to this privately, the only thing I'd add to my my explanation on the status quo as I see it is your introduction of PEP. PEP assumes that HIV is already in your body and in a quantity capable of causing an infection. It's prescribed for 28 days for a reason: to get every last bit of HIV out of your body. Your proposition has you in the position of the girl who's getting her morning after contraceptive pill from Accident and Emergency every weekend. If PrEP isn't available in Canada yet, I'd wait till you got a reliable supplier before you start taking it. It's very rare, but one of the ingredients in truvada can kill you, which is why it's essential to take it under medical supervision. PrEP is approximately as effective as prper use of condoms, more so if you're fucking with someone with someone who's HIV+ and has his VL under control. The effectiveness of PrEP doesn't change over time, at least not that's yet been seen. What we are learning is that guys who don't have HIV react differently to PrEP insofar as the lucky bastards are less prone to side effects. As long as you take your PrEP every day, you're at a minuscule risk of getting HIV. As soon as you skip more than a few days your risk starts increasing until you're back at the starting point, which tends to happen within a month, no matter how much truvada you've swallowed in the past.

To quote Rayne: "I believe safe sex education is more along the lines of: 5 parts scaremongering, 2 parts science, 2 parts bullshit to glue it all together, and 1 part personal interpretation of whoever is "teaching" you the "facts" you are given." I don't know what it's like in the USA, but in the UK sex educational is optional (a recent proposal to make sex, health and relationship education was voted down). I used to live in a village 20 miles away from the nearest town of anything but tourist importance. One bus a day and the local kids knew that if asked an honest question, they'd get an honest answer - I was "uncle" to five of them, by way of my friendship with their mother motherwith whom I'd would have peculiarly frank discussions at times, usually after, I'm afraid, a bottle of wine. Consequently everyone in the valley knew about "gay Steve". The ridiculous thing is that I could have those conversations on the bus with the kids, yet the school couldn't invite me in to do a proper job of education (though such question and answer sessions undoubtedly opened the eyes of some of our elderly neighbours!). It's the fact that they're teenagers: everyone knows that as soon as a teenager knows about sex they're at it like rabbits. No matter that the knowledge might just save their lives. No-one in UK politics (and I presume it's the same in the USA and other countries) dare suggest that, actually, it might be a good idea to teach the kids about sex. I've led seminars for social services workers about HIV, its history and transmission and have heard on the grapevine that my seminar had been voted the best, most informative one of the the lot. Why it is that those organising training/teaching about sex, health and relationships can't involve and learn from those who know most on the topic is, I'm afraid, beyond me...

As I said: it's got to be a local shortage. There's a hospital in Cardiff that won't dispense more than a month's worth at once, whereas the hospital I use, forty or fifty miles westwards is happy to prescribe four of five months' worth at a time...

Way to ensure a life of celibacy!

The Truvada you guys get as PrEP is identical to the Truvada we get as treatment. It's got to be a local shortage: just in the past couple of weeks there have been reports of the uptake of PrEP being much lower than expected. Last time I remember a shortage, no, famine, of an HIV dug was that dreadful year around the turn of the century when ritonavir was only available as the most foul tasting liquid imaginable!

Couldn't agree with you more more Tiger, even though decades separate our diagnoses. Plus you've taken everything I meant to say and said it better. ;-) All I can say is to repeat myself: find a support group and learn to open up. You don't say where you are: if you don't have a support group in easy reach, I'm happy to talk via personal message. Hell, in a tiny little country like Wales we only have a couple of support groups... Steve

An impossible question as we're all different. I'm a member of the UK's original Long Term Survivors' Group whenere all you had to do was present a letter from your consultant that you' were diagnoses five or more years ago. What's 5 years these days? In 92 it was a hell of a lot - I think two or three of us survive from those days. I personally would lkike to see a Methusalah group, even though I don't come from the Judeo/Christian tradition and we have had some some very useful meeting as part of a NLTSG weekend. We've also started running "newly diagnosed" weekends whose time limits are less constrained: just when you're ready for them. It can be a month or or two it can be a couple of years. If I were more sure of my facilitation skills and hadn't had such an appalling couple of years I'd be involved in helping out with these as well. It all sounds very "touchy-feely" but that's not the way it comes across. I suggest such a weekend in your area if there's one available: a hell of of a lot of guys get through it all without, but equally a hell of of a lot of guys get through it because of it. Basically, what I'm saying is take support where you can find it. Not the "I feel your pain <hug, sob>" but building up real relationships with real people, who ARE going to answer the phone at midnight. When I walked through the poz/neg door, you were lucky to get another five years. What's the point of bitching about twenty odd extra years? Things change and we're going to see things change further. I'll probably be dead of a heart attack or a cancer before my immune system gets low enough again for HIV to be implicated in my death. Which isn't to say I'm not going kicking and screaming (though nice and quietly in my sleep might be a plus!). I expect to live to see a functional cure (men in my family tend to be be short lived), I hope to see a total cure. Find a suitable support group (it might be round the corner, it might be across town - up to you) and attend regularly. You'll start learning how to deal with HIV and eventually learn to support other guys who are newly diagnosed...

Stribild is the new "Quad pill", so called because it contains four different drugs. Atripla contains two of those drugs (FTC and tenofovir). Complera I know little about but know people who are using it successfully. I am undetectable and my CD4 is 1140. Something's obviously working! I've hit zero as viral load, but I've never been above CD4 880. My advice, as ever, is "if it ain't broke, don't fix it". In the "old days" when it was felt you couldn't go back to a class of drugs that had failed you (but then there was an awful lot else we didn't know that we know now). The big difference between then and now is that we didn't know how the correct dosages and we didn't know how to safely swap out of combinations: a friend of mine has just swapped out of nevirapine after fourteen years on the stuff. The ones to watch for and report any side effects to your doctor (though obviously you should be reporting the lot!) are efavirenz because of its CNS effects and tenefovir because the kidney damage seems to be permanent: I've just been recalled by my diabetes clinic as they're not happy with with my last bloods following prescription of a blood pressure medication. (Just as well I've got nothing lined up involving heavy poppers use!)

RWHID, have you considered counselling? In the UK we're noticing more and more that people get more from counselling after they've lived with HIV for six months to a year, which is one reason that the Long Term Survivors' Group has started doing a couple of Newly-Diagnosed weekends per year as well. You say that it's an emotional ride: you're not wrong there. It's kinda like we're the target for other people's ignorance and they don't actually realise that their words are the language of prejudice. One of the projects that the charity I work for (as a volunteer - after 25 years of treatment I'm too worn out now to maintain a working week) is a message board open only to people with HIV. If you want the address, drop me a PM.

Also PinkNews isn't the most reliable source of information. Some of their HIV coverage is truly shocking in it's distance from the truth!

In my experience real ginger guys are Celts, having coarse red hair, and often a distinctive odour to our pubes that only some notice (and some actively dislike). We go directly from ginger to white with ago with no thinning of hair and we rarely go bald.

Thank you Real ginger hair is probably the thickest hair type for caucasians - certainly the coarsest - and I've found whatever's on special works. What you're paying for is the packaging and the perfume, not the actual conditioner. By the time you've been round Wikipedia and doing the research you might as well have just have bought the cheapest on on offer...

Hair conditioner helps stop body hair from getting too itchy as it grown back (experience from the few times when I had no choice in the matter), but I'm firmly in the "let it grow" camp...