To PreP or not to PreP....

[Guest JizzDumpWI]

Hey guys... First, this post is not at all about chasing. I am not looking for feedback along that line. Please don't reply if your thought is something like "get poz, be the + fag you were meant to be"... This is NOT where I am attempting to go with this post.

I have been enjoying BB only sex for the past 37+ years... So all through the AIDS crisis to current BB has been all I do. Recently my favorite clinic gave me the PreP talk. And I confess the ID doc and his cute nurse make the prospect of regular visits all the more enjoyable... Probably side effects of Truvada will be low (unless they aren't).

My dilemma is why bother at all at this point in history? ID doc thinks I have just been lucky. But that seems rather fantastic over the many years. I am not opposed to PreP, especially if side effects are low/none. But I wonder if it makes sense at this point? On PreP I am on HIV meds. Else if I did seroconvert I am on HIV meds...

I need some of you clear thinking buds to open my eyes to some perspectives I might be blind to...

Thanks.

[TigerMilner]

But you will prevent your immunue system from being engaged with HIV. Even when the meds are working, your immune system is still fighting it. That is how the fatigue part of it was explained to me. That alone is worth not getting pozzed. You can't imagine what fatigue really means til you experience this one. If you can get Prep on your insurance or free, do it. Yes, either way you are on meds, but with Prep, you don't have a deadly virus waiting for the opportunity to kill you.

[fskn]

One way to think of it is that Truvada for PrEP is a 2-drug regimen and that you'd be on it by choice. If you became positive, on the other hand, you'd be prescribed a 3-drug regimen (at least), and you wouldn't be on it by choice.

As TigerMilner said, why not try PrEP, assuming that you have access to medical insurance, to an assistance program from the manufacturer, or to one of the studies currently underway?

[bearbandit]

Go through the negatives first and decide if you can put up with them. Truvada is an excellent anti-viral, but it does have a nasty side. First, and most obviously, can you adhere to the regime? Always take the drugs within an hour or so of the time you took it yesterday? Some people find this extremely difficult, though of course if you're on meds for another condition it becomes easier as you just tie the two drug events together.

FTC (the more benign component of truvada) doesn't have much baggage associated with it, but the tenofovir component would necessitate regular liver and kidney checks which you can't afford to miss as you can go from "normal" to seriously ill in a matter of weeks. Other effects of tenofovir include IBS-like symptoms like excessive farting and bloating which can usually be got rid of with peppermint oil and, rather more worryingly, the inability to retain calcium, leading to osteopenia.

Some people find Truvada a non-starter within a month or two. They can't tolerate the effects of the drug and unfortunately, it's the only one licenced for PrEP. I wonder whether the science of the problem or the money they could make was the main motivation for Gilead?

What would you gain from it? Obviously the peace of mind that HIV's going to have one hell of a job getting to you. A more cynical attitude might say see what happens without: most HAART is three or four drugs, so with Truvada you're only getting half the picture and the drugs are improving year upon year: you and I are about the same age and have been walking round the block for the same amount of time, but I got HIV right at the start: I can assure you that if you were to seroconvert you wouldn't have anything like the shit I've talked about. It could well be that you've got an unusually high resistance to HIV anyway.

The more I think about it, the more I try to put your boots on, the more I think I'd be inclined to continue to take my chances and do without Truvada: my doctor's comment on PrEP was that it was proof of a concept, but needed a lot more work. However, some of that work is coming at the end of the year when the reformulated tenofovir will be on the market and will be the version that's used in Truvada: this version does a better job of hanging around the places where HIV likes to hide, which will lead to fewer side effects, maybe even solve the osteopenia problem.

Sorry my reply is so confused: I've been writing as things come to mind. Some guys seem to go on for one hell of a time with repeated exposure to HIV and never get it themselves: host of the party I was at last weekend is another case in point. Thirteen or fourteen years since his partner serconverted and he's still testing negative and holding biohazard parties...

[Guest GoodExercise]

The drug reps are out there pushing PrEP on the MDs, and the MDs are only too happy to go along. You would think that this stuff is candy the way that they want to hand it out. It seems extreme to me. I just took a survey on PrEP - designed to figure out how to better market it. I made up some fictional but plausible responses. Screw them before they screw you. Talk about increasing ROI, they will have our pets on the stuff next if they can talk us into it. 37 years BB and neg? But you could get infected tomorrow, so let's risk your liver to prevent that.

[rawTOP]

I'm on PrEP. (BTW, notice the proper capitalization). My suggestion is to first get a DNA analysis to figure out if you're immune or resistant to HIV. If you're immune then there's no point. If you're resistant then it makes the need for PrEP less urgent. The DNA analysis can also tell you whether you're likely to be an "HIV Controller" (aka long-term non-progressor). If you're a controller then your body can naturally keep your viral load load low and being poz is far less scary. I got my DNA analysis at 23AndMe.com - they do a good job of showing that and far more information to you. I doubt a test at a regular lab would be as informative (though insurance may cover it). And BTW, please follow the link rather than typing in the URL - I'll get credit for referring you that way.

And just to clear up one item - BearBandit is wrong - you don't have to take the meds within an hour of when you took them the prior day. The ingredients in Truvada have rather long half-lives and unlike poz guys you don't have HIV in your system - so you don't have to be so consistent. Though you do need to take the meds every day - it's the only way they're somewhat sure the PrEP will be effective - though they're doing studies to see if lower doses or "disco dosing" can work (taking it right before sex and for a few days after).

I suspect your immune or resistant. Figure that out first and then use that information to figure out how much risk you're taking. If you're constantly taking anonymous loads and you're not resistant, then I would say go on PrEP.

[TattPig]

"The drug reps are out there pushing PrEP on the MDs, and the MDs are only too happy to go along."

That completely ignores the fact that there is real science and real research that proves that there is real benefit to PrEP. I find that anti-science attitude very disturbing; it sounds like the drivel that the Tea Party and Sara Palin and Suzanne Sommers spout. I'm not saying that PrEP is without potential downsides. But that attitude (and the runaway fantasy about our pets) contributes nothing to an intelligent discussion of the question at hand.

[bearbandit]

And just to clear up one item - BearBandit is wrong - you don't have to take the meds within an hour of when you took them the prior day.

I admit to being wrong in terms of practical adherence: I was quoting the general advice given in the UK for people with HIV for perfect adherence. My reason for doing that was experience has shown in the UK that a 26 hour time difference soon turns into 28 hours and so on so that drug levels do get the chance to drop. It's better to be over protected than under protected.

I don't have anything against PrEP: in fact I think in theory it's a bloody good idea, but I think we have to be clear that Truvada is only the first attempt at PrEP, with the second attempt coming up at the end of the year with the new formulation of tenofovir and therefore truvada. I'd like nothing better than to be wrong about my Cassandra complex, but I can't help but advise caution. Much as I like the idea of TasP (treatment as protection), it relies on him believing me whereas with PrEP you know yourself that you've done everything possible.

[Guest JizzDumpWI]

Man, you guys rock! This is exactly what I was looking for when I posted. Thank you. I hope as a thread, this proves useful for others too.

TigerMilner & fskn; excellent points about benefit of avoiding vs treating; and indeed only two drug cocktail vs a 3 drug. The sort of reminder for my brain I needed. Clearly I was equating them incorrectly.

bearbandit - you and I have talked about this before. {Sometimes I think you and I are brothers/cousins. We're alike in many ways and yet unique too. (Varley is a pleasure BTW)} And for the most part, it is what gives me pause about starting. My (cute) ID doc was pretty forthright about the potential for side effects; and would be available should I begin to experience any. Since more do well than not; I think PrEP (thanks rT) makes sense to try. Added fact that copay was picked up over what my insurance pays (thus zero cost) is a nice benefit and incentive.

GoodExercise; thanks. I took that same survey. BUT I don't see any value in taking time on a survey giving fictitious answers. I can't disagree with you that the drug companies are about the profit motive - seemingly as their #1 priority. We owe that on much of our free market system. Is altruism dead?

rawTOP. Yes I know you've been on PrEP (thanks for correction - I definitely appreciate that). I did do the 23andme genetic testing. And am not immune; although I have 50% of the required genes to be "immune". Am also a slow progressor so should I contract HIV, I do have that going for me. You know, if I knew for certain that HIV would knock off asthma, allergies and arthritis - my daily nemesis - it might even be worth it. But my poz buddies sadly still get to "enjoy" those same maladies if they had them to begin with. I particularly appreciate you pointing out 23andme; and bring up PrEP so forthrightly rawTOP. One day I would like to meet you in person, sit down to dinner, and hear more about how your interesting career unfolded.

To the point of exposure; while I'm not nearly the slut in practise that I am in my head; I take several raw loads from guys I don't know each month. It is because of that my (very cute) ID doc {let's make that his official name "VCIDD"} is encouraging me to start PrEP.

... an aside for 23andme. While I did that wanting to get a bead on my genetic data and what that suggested about health; I liked the profiling of my genetic family. It was quite a surprise that in part, I am Indian (asian). No doubt connected with colonization by my English, Welsh, Scottish, Irish ancestors which are the major part of my makeup.

TattPig; I appreciated that input. Very true that there is a huge body of science around HIV and other viruses. And we're on the same side in being disturbed about the political discounting of scientific facts. My family background is in medicine and drug research; so I have people close to me who I trust who've been part of the research. It has occurred to me that the right wing has added a long long wing extension to get as far anti-science and anti-human rights as they appear to be.

bearbandit (again); so much of this is relatively new; not baked into the minds of all of our larger community. So I don't honestly know for certain the timing limits of PrEP. VCIDD suggests to me to keep variations within a two hour window most of the time. When we discussed it I posed a few scenarios (like traveling to different time zones and how that messes with our body clock). He is pretty comfortable if I maintain that sort of schedule 29 days out of 30.

jizzdumpwi... So, I picked up my prescription at my local drugstore, and was delighted to find my copay was $0. I can afford that. I imagine that won't always be the case. But since we won't know of side effects until we know; it is sure nice not to have an expensive hit for what might prove to be an experiment. To the point of compliance. I already take daily drugs to control herpes, allergies, blood pressure. One more isn't going to make a difference to me.

Thanks guys. I appreciate your posts more than you know or I can adequately express.

JD

Edited August 3, 2013 by JizzDumpWI

[foxb]

The idea that the drug companies are pushing PreP is rubbish. Talking with one of the lead researchers for the UK trial the UK is seriously considering this mainly because in 2015 the patent runs out for the drugs so they can make cheaper generic versions on the NHS. I'm on the Trial in the UK (although wont start my treatment until start of 2014) and looking forward to whatever ever happens.

[wood]

I'm on PrEP. (BTW, notice the proper capitalization). My suggestion is to first get a DNA analysis to figure out if you're immune or resistant to HIV. If you're immune then there's no point. If you're resistant then it makes the need for PrEP less urgent. The DNA analysis can also tell you whether you're likely to be an "HIV Controller" (aka long-term non-progressor). If you're a controller then your body can naturally keep your viral load load low and being poz is far less scary. I got my DNA analysis at 23AndMe.com - they do a good job of showing that and far more information to you. I doubt a test at a regular lab would be as informative (though insurance may cover it). And BTW, please follow the link rather than typing in the URL - I'll get credit for referring you that way.

And just to clear up one item - BearBandit is wrong - you don't have to take the meds within an hour of when you took them the prior day. The ingredients in Truvada have rather long half-lives and unlike poz guys you don't have HIV in your system - so you don't have to be so consistent. Though you do need to take the meds every day - it's the only way they're somewhat sure the PrEP will be effective - though they're doing studies to see if lower doses or "disco dosing" can work (taking it right before sex and for a few days after).

I suspect your immune or resistant. Figure that out first and then use that information to figure out how much risk you're taking. If you're constantly taking anonymous loads and you're not resistant, then I would say go on PrEP.

This is exactly what I would do. However I would also say it depends on what type of sex you are having, IE always bottom, always top, etc.

I havent done my analysis, but will eventually, and am going on PrEP, as my script is getting filled right now.

[Guest JizzDumpWI]

Day 3 on PrEP really a non issue. But the time really needs to pass to see if there will be any liver/kidney issues... Short verdict though is no immediate reaction. I notice a new feeling not unlike that new poz guys report... I really don't need to think about another guys status... So the purported "benefits of being poz" without compromising my immune system (unless I am) I get from PrEP.

rawTOP maybe a PrEP subforum here so guys on PrEP can compare experiences?

JD

[rawTOP]

rawTOP maybe a PrEP subforum here so guys on PrEP can compare experiences?

Good idea. I'll move this thread and some others into their own area.

[headnurse20]

I have to say as a bottom and a nurse, I love this open frank discussion of a VERY important topic. I have been considering PrEP myself. I need to look into that genetic testing site since I have been with alot of unknown guys and several who were poz-undetectable and I haven't seroconverted. I am not a chaser and honestly would prefer to stay neg, but I CANNOT give up taking bare loads.

[wood]

I have to say as a bottom and a nurse, I love this open frank discussion of a VERY important topic. I have been considering PrEP myself. I need to look into that genetic testing site since I have been with alot of unknown guys and several who were poz-undetectable and I haven't seroconverted. I am not a chaser and honestly would prefer to stay neg, but I CANNOT give up taking bare loads.

I would go on it asap if I were you. The statisitcs say that the vast majority of people are not immune or resistant, so while you may have got lucky in the past, I dont see any reason not to be proactive in the future.