bearbandit

The only new component of triumeq is dolutegravir which I'm taking as a stand-alone. Since it mustn't be taken near vitamin or mineral supplements (because the molecules of the supplements can latch onto the dolutegravir molecules this restricting its absorption - slap your doctor if they didn't warn you about this!) I take it last thing at night. I'm only a couple of week into it and all I've noticed is a difference in my sleep pattern which could well be from other causes. I'm betting it's life getting in the way of sleep as I had no problems at all with raltegravir. I "upgraded" from raltegravir at my doctor's insistence: the only other option would have been darunavir/r monotherapy which has shown good results in trials, but she felt it wasn't enough for me with my history of resistances and allergies to drugs. Lamuvudine is perfectly tame in the side effect department, but I haven't taken abacavir as I'm one of the 8% of people of north European origin who have the gene HLA*5701 - this makes severe allergy almost a certainty, and restarting abacavir after an allergic reaction linked to 5701 usually results in death. Depeding on what you pay for your meds, it might be worth asking about asking about what they'd cost if they were three separate pills. A recent report quoted by www.aidsmap.com said that there was no difference is efficacy between taking a compound pill or the individual ingredients, and that, in the UK, we could expect to see a reduction of the use of compound pills as they're a way of extending patents and cost up to five times more than their components supplied individually.

And thank you for all the work you've put into the site for us...

That's right - prove me a liar! I often say that the reason you hear so much about side effects is that no-one post messages like yours. I've long thought that atripla, or more specifically efavirenz should be put on the "emergencies only" list, as it were. Although it's very good at getting the viral load down, it probably has the worst side effect profileof any drug in still in use. Pozbtm4breeding's comments about feeling so much better for changing to triumeq remind me of how I felt when I stopped taking old-formulation ritonavir and realised how ill it had been making me.

No problem, GermanFucker... In every graph I've seen showing progress of HIV disease, the viral load never again reaches the height of that initial spike after infection. True, it rises again, but by that time it's killed off enough of its host cells: the cells of the gut and a certain skin cell are other types it likes: it just likes CD4 cells more. But at least that explains the resurgence in weight loss before death, and the difficulty many PwHIV have with skin problems. No, it's not rude to ask: how else are we to make sense of the whole epidemic without asking questions? John was a hypochondriac of the first order, to the extent that I refused to allow medical books in the house. He worked with in a hostel with homeless men with "substance use" problems and one day was first on the scene when a guy had hit an artery instead of a vein. When that happens you haven't got time to go looking for gloves, face mask etc: a single minute can make the difference between life and death. John ended up drenched in this guy's blood while putting a tourniquet above the bleed site and shouting for someone to get an ambulance. Apparently they got the guy to hospital in time... We didn't really think any more of it: we were used to him coming home from work and announcing that he was loused up again which was my cue to run a bath, get the Quellada out and for him to strip at the front door so I could get his clothes into the washing machine. That was about 1997 or 98. He had shingles in 2000 which made me raise my eyebrow a bit, but I thought "he's over forty, in a stressful job, an ideal candidate for shingles" and left it at that. It was only in 2003 when he had a needlestick injury at work, who had, by then, instituted an HIV policy to protect staff, that he tested. It turned out positive and his CD4 count was low enough to count as aids in the USA. He'd started a diet (he was a big guy at 250 pounds and 5'8") at the beginning of the year which was going well: it turned out that the reason for doing well was that he had MAI in his guts which was preventing him from absorbing food properly. In one of his many "how did I get this?" sessions he added in another detail to the guy who'd hit an artery while injecting: he'd taken mouthfuls for blood and though he tried to spit it out, he had appalling oral health). The company he'd worked for had a policy of gicing all front line staff a free life insurance policy worth a year's salary to go the partner if you died as a result of an incident at work. Even after John's death I didn't think about this: when the life insurance company tracked me down I thought it was some other policy John had taken out without me knowing. Because we hadn't married, his mother had to do the negotiations with the insurance company and when she told me the sum of the payout I knew exactly where it had come from. She also skimmed nearly 50% off the money before it got to me, so guys, if you haven't made a will, even if you're legally married, MAKE ONE! Don't think you can trust even your family: "we don't want a penny of it: you'll get the lot" became "we thought X deserved some money and Y, and Z..." I knew John's sexual practices very well, even though we never had sex after I started the original version of ritonavir (the chemical castrator): he didn't like ass-sex except for pissing into an asshole or giving an enema, he wasn't much into sucking or being sucked. For him it revolved around cigars, forced smoking, breath control (I still miss having his initials cigar-branded on my chest). There's no doubt in my mind that he got HIV through getting facefuls of blood: I know how much it takes to establish an infection, which is why I'm always dubious about claims that "I got it from cocksucking". Most likely John also got infected blood in his eye (hard to see how he didn't), which is a highway to the brain... Sorry to have talked at such length, but I wanted to make it clear how fuckin' difficult it is to get HIV through oral sex, and what it does take to get it through the face...

"End-stage aids patient" - I assume you mean someone with an extremely high viral load. For most people their VL is never higher than when they're in serconverion illness: shortly after infection there is a massive spike in the viral load accompanied by a drop in CD4 cells. Most treatment will reduce the viral load to indetectable within three months - stories of guys achieving undetectable within a month a becoming increasingly common. If someone is reaching the end of their life and it's aids that's brought them there, they may well have a low viral load, as it's not HIV that kills people: it's the opportunistic infections. My partner who died in 2007 was undetectable at the time of his death. Saliva is the beginning of the digestion process and it's long been known that an enzyme in saliva is inimicable to HIV, and what remains of any HIV swallowed is killed of by stomach acids. There needs to be an entry point: the damage sufficient to let in HIV is such that treatment in and A&E might be more appropriate than oral sex. I like your point about the guys who swear they got it from sucking cock: I've long maintained that the transmission figures are distorted because of closet cases who somehow feel that suck a dick is somehow "less gay" that taking it up the ass. I tend to put the risk closer to being hit by falling space debris... ;-)

I'm afraid that the paper you quote, seaguy is dated 2006, making it nine years old. In HIV terms that's ancient history. Latest I heard on superinfection/reinfection was last year from the charity I used to volunteer for (the usual boring not agreeing with their methods and stuff) where the news was that superinfection happens maybe twice a year in the entire world. Mutated virus is weakened virus and someone on treatment is effectively on superPrEP so a mutated virus would be wiped out immediately. So even if the virus mnanaged a foothold in someone's body, their drugs would wipe it out. Drug resistant virus happens occasionally, but with the aim of treatment being to keep someone undetectable, they start monitoring drug levels etc (in the UK, at least) every time you have a blip, even though it takes a viral load of 1k to do a resistance test. I have a pretty bad record of resistance and side effect issues, so much so that I'm on salvage therapy, waiting for whatever new drugs come along, but even I manage (most of the time) to have an undetectable viral load. The highest it's been, including in 2012 when my drugs conspired to try to kill me, is about 150, and the general rule is that it takes a VL of 1k to be slightly infectious...

Paradoxically, the safest guy to get fucked by is a guy whose HIV is fully controlled (ie undetectable, usually defined as less than 50 copies of the vrus per millilitre of blood): no-one, but no-one, with a viral load under 200 has ever infected anyone else. Neg/neg serosorting doesn't work: you might think he's neg, and he might think he's neg, but unless you met him at the clinic you don't know what he's been up to. The longer it is since a guy's tested the less you can rely on the words "I'm neg". There's a regular sex party near where I live that nearly stopped happening because the organiser fucked with me and I make no secret of being positive (indeed I was recently in one of the intellectual Sunday newspapers talking about life with HIV, complete with photographs). The guys who usually go to the party all bareback, yet consider testing once a year sufficient. Wrong! Every three months is closer to the mark. and if you're really popular, more frequently than that. Think about it: the only people who can be sure of their HIV status are virgins and those of us who've got it.

If you're on treatment and it's going well (as in you've got your viral load down to undetectable), you're effectively on a superior form of PrEP as far as HIV is concerned. So you get fucked by a guy with a strain of HIV that's resistant to one of your drugs. The other drugs you're taking are going to hit it. And that's if the new HIV even gets as far as trying to establish a new infection. One reason that PrEP works is that virus that's resistant to both emtricitabine and tenofovir is incredibly rare: it's only been seen a few times. Another thing to remember is that resistant virus is weakened virus. In time the wild type (non-resistant) virus crowds out the resistant virus, which is why many drugs can be re-used some years after someone's virus became resistant to them. The main reason for changing drugs is because of interactions and side effects: resistance is rare, but it does happen. The chances of getting laid by a guy whose virus is resistant to even two of your drugs is pretty remote. My personal feeling is that syphilis, gonorrhoea etc represent a far greater risk to my health than the extremely remote chance of taking on board a load that's resistant to all the drugs I'm on. In one respect it's time to go back to the seventies when the standard advice from any gay helpline was that sexually active gay men should be having a full STI workup every three months whether they have symptoms or not. STIs can do enough damage to people who don't have HIV, we're more vulnerable to them and a number of them have no noticeable symptoms...

For the drugs that wikipedia lists, they generally have a sidebar on the right-hand side. You want the pharmokinetic data section, specifically the excretion details. I just looked up my blood pressure meds and its exretion is 40% renal (ie in piss) and 60% faecal. That said, I'd venture that even in a long session you're not going to be swallowing much of the drugs he's on unless you're a 24 hour urinal.

That's the beauty of PrEP: instead of responsibility for HIV transmission being dumped on us poz guys, PrEP means that neg guys are taking responsibility for themselves, something few have done, always relying on us to tell them our medical histories. BBRT began, as I understood it, to make hooking up with other poz guys easier and I, for one, wish it would stay that way. While I've seen little phobia from the kink community, out in the more general sites, and on the less kinky apps, saying you're poz in your profile guarantees you a major drop in hits.

Thanks for the graph: I've been looking for a copy of it for a while as illustrates the point well, but the time scale and overall shape of the graph will vary from person to person. For example, I got to about year 9 with nearly four times the number of CD4 cells implied here - this was during the eighties. I have of course "borrowed" the graph...

Sometimes if a guy's sloppy about adherence to meds (or is dealing with another infection such as another STI or general infection) his virus can become resistant to one or more of the meds. Usually this only happens with one medication our of the three or four most guys with HIV take. For the guy whose virus has developed resistance to a drug, the answer is to change drugs. If he's passed on the virus (often resistance is first noticed by the viral load increasing, so that he becomes more infectious) then the guy who picks it up will have the resistant virus, which is why when someone's diagnosed positive, they do a resistance test. This tells them which drugs (if any) the virus is resistant to, and the drug combination is tailored to fit. It's worth noting that HIV tends to the wild type in the long run, which means that after a break of some years, a particular drug may be re-used. Superinfection, as seaguy noted above, is rare: think about it. Someone's on ARVs and takes a poz load containing another virus type. All HIV is vulnerable to the same drugs, so the guy's existing prescription is going to knock out the new virus, pretty much the same way that truvada does.

There's at least one closed group on Facebook focussed on PrEP, populated by people on PrEP, or interested in PrEP, some poz, some negative (as you have to be to get PrEP). Being closed rather than hidden, you can search for it , but can't see any of the posts without asking to be a member. I'm also a volunteer for an HIV charity and therefore keep up with the news: http://www.aidsmap.com/ is well worth a look.

  &Which is why I'm so keen to get neg guys on PrEP: if I pick someone up in a bar, what reason does he have to believe me when I say I'm poz undetectable? If he's on PrEP, he knows for himself how good his adherence is and that if he's taking the pills as directed then there chance of his getting HIV are on a par with a big lottery win...

If you never miss a dose (one or two hours is well within the window period), someone on a PrEP group on Facebook that you were more likely to win big on a lottery than get HIV, no matter his VL. PrEP is about as safe as you can get. There have been one or two seroconversions, but the evidence suggests strongly that the guys involved were in the window period (ie right at the beginning of HIV infection) when they started PrEP. Three months later, their HIV status would have been picked up by the routine HIV testing which is part of the PrEP protocols.

Of people taking PrEP, both "in the wild" (ie in the USA and other territories where it can be got on prescription) and on various trials, no-one who's fully adherent to the regime has ever seroconverted. Get sloppy with your adherence, missing doses and it starts becoming a possibility, just as a PwHIV who gets sloppy with their meds is liable to find their viral load rising and their CD4 count dropping. If you think about it truvada is two thirds of a standard ARV regime for PwHIV. After a couple of weeks, your tissues all contain the drug, in particular the mucous membranes inside your ass. Last time I got fucked was by a guy who viral load was pretty high. a month or so later my bloods showed VL undetectable and my CD4 was at its second highest count ever (and I've been having CD4 counts since 1989). Stick to taking the truvada, if you take it in the morning keep it next to your toothbrush, or with the breakfast cereal, anything that helps you develop the habit of taking it. Then you'll know that when you feel ready to get fucked or fuck raw, you're as protected as you can possibly be at our current level of knowledge.

Effectiveness depends on your genetic make-up as well as the drugs. For instance 8% of northern Europeans have a gene that makes the popular drug abacavir potentially fatal. Trust me: I'm one of them! So all you can do now is take the pills without missing any doses and up that they work. Starting them at the 24 hour mark greatly enhances your chances. PEP is a "soon as you can" solution: after 72 hours it's pretty much ineffective as HIV gets a foothold fast. Here's hoping your luck holds! The drugs are pretty heavy chemicals, so it's not surprising that many have side effects when they start them. I'm afraid all you can do is wait them out. Some imodium would help with the diarrhoea (the lopinavir/ritonavir combination causes that - the protease inhibitors are infamous for diarrhoea!). Try eating higher fibre foods than usual: muesli as a cereal will help a bit too. You're doing well to have the side effects subside so quickly. When you research anything to do with HIV, disregard anything that was published before 2014 (unless it's an opinion piece) - things really are changing that fast. Again, best of luck: you've got everything going in your favour...

Which drugs are you taking? If one of them is twice a day it's probably Isentriss (raltegravir) which has a pretty low side effect profile. But different doctors prescribe different drugs for PEP: basically you're on the same sort of regime as a PwHIV. I'm afraid I can only offer advice if I know which drugs (I've been poz so long that I've taken most of them at one point or another)

"She told me that truvada was one of three HIV medications for HIV positive people, not for people without HIV." There are, in fact, over twenty medications in use in the UK. With such an appalling lack of knowledge, I'd be tempted to name and shame her!

Diabetes (the result of high dose ritonavir, d4t and ddI), high blood pressure, high cholesterol (both prescribed drug-induced), lipoatrophy, lipodystrophy (the balls of your feet are fat: I walk, painfully, on skin and bone), Fanconi's syndrome (tenofovir poisoning: kidney damage severe enough that I piss away minerals and vitamins that should be recycled, and no, it's not reversible damage; yes, it can kill you - I was about a week from checking out before I was hospitalised), osteopenia. ED (the standard drugs are incompatible with my life-savers) such that I can't top any more. Isolation - your friends are always doing something you physically can't manage. Not 1, not 2 or even 3 pills a day: try 30. That said, I've got an undetectable VL and over 700 CD4 cells, so I count as healthy. Still fancy the idea? Take your PrEP!

ex-social worker, can't work due to effects of early HIV drugs. Volunteer online for an HIV charity, writer (porn and political re HIV).

For me it was the awareness that the Condom Edict of the early eighties, that we thought was only going to last five years, was still in force thirty years later. Anti-retrovirals mean that I'm essentially non-infectious (I can't rule out the possibility of blips in my viral load, but a jump to infectious levels would most likely be accompanied by illness of some description: the normal blip is less than 100 points) and superinfection remains pretty much theoretical in that it happens about once a year in the entire world. So why the hell not? I couldn't think of a reason: I'd been BBing with other poz guys who I knew reasonably well since the late eighties, and loathe the sensation of rubbers (to me their only use is to deny a bottom the cum he wants as a punishment). ED makes it rare for me to fuck as the standard remedies don't work or give me all the side effects and none of the fun, so I'm more likely to end up getting my ass filled. Shit, but I've missed that sensation!

I prepare by eating only muesli for two or three meals beforehand. After that it only takes a shit and a few goes with a small douche to be completely clean - the douche is really only for insurance. I'd add that this works well even though I take a couple of protease inhibitors which are well known for causing diarrhoea, but they're probably off-set by the fact that I only eat wholefoods: stuff like wholemeal bread and brown rice.

I'm a volunteer with our national sexual health charity (THT). I've made no secret that I despise rubbers and have published at least one column for a British based magazine saying so as well as on the message board of the charity. When I became a moderator here, I felt I had to explain a possible conflict of interests with what would be my line manager if I were a paid worker, especially since the charity's position is condoms all the way. Manager's view? Thanks for telling me: probably the wisest thing to do. And thanks for the URL to the site - I'm loving it... So basically everyone...