Wanting to start PrEP

[Bbpozboy]

I wanna start taking prep but I have no idea where to start. I'm in Madison,WI it's fairly gay friendly here. Would I have to go to my normal doctor first? And I'm not sure if my insurance will cover anything got it.

[cain1]

I've been seriously thinking about it too. I'm in Minneapolis. I plan to go to the Red Door this Thursday. Do you have a men's clinic, gay clinic? Could be a good place to start. :-)

[fskn]

PrEP suffers from its novelty, from a misquoted effectiveness statistic,* and from the fact that what little experience a doctor outside a major metropolitan area (or with a non-diverse practice) might have in prescribing HIV medications necessarily involves treatment rather than prevention.

It might be helpful to bring a printout of the press release announcing the FDA approval of Truvada for PrEP last year (Google "fda approval prep"). This has links to prescribing guidelines.

Separately, you should read the evidence of coverage for your health insurance plan. What are the deductibles and copayments/coinsurance rates for brand-name prescriptions? For lab tests? Does the policy contain a blanket exclusion, for something like sexual health? (As PrEP is now FDA-approved, the near-universal exclusion of "experimental" treatments no longer applies.) Is there a prescription drug formulary (a specific list if covered drugs)? If so, you'll have to go online or call to find out whether Truvada is listed. Provided that you meet the prescribing guidelines, PrEP will be covered on exactly the same terms as other drugs.

It's wise to know the prescribing guidelines yourself. A conscientious doctor will order a qualitative PCR HIV viral load test to provide timely confirmation that you are HIV-negative. (The two drugs in Truvada are strong enough for prevention, but three drugs are typically prescribed for treatment, so PrEP is never started if there is a risk that you are positive.) The doctor will also order a kidney test. A liver test and some assessment of bone health should also be done. Once your results come back, you will receive your first prescription. The HIV and kidney tests should be repeated every few months, before renewals are approved. Kidney and bone side effects are relatively rare, but are very serious when they do occur.

* Some authorities failed to read a key research report in detail, and are quoting an average efficacy rate. Efficacy for patients who adhered to the drug regimen was above 90%. It stands to reason that drugs only work if we take them.

[bearbandit]

Some excellent points, fskn. PrEP is still in trial in the UK, but the general feeling is that conscientious adherence to PrEP (not missing more than one dose per month) is "probably" better than condom use. It's essential that the follow-up bloods are done: FTC is relatively benign, but tenofovir can be a bitch. Although there are only about 75,000 people in the UK in treatment for HIV, I personally know at least four who've suffered bone damage from from tenofovir, and more who've had to move to another drug because it looked like they were heading that way. Kidney effects: well, they nearly killed me last year (about 1 in 100,000 people get to this point).

However, this data is anecdotal and comes from people with HIV: it's now recognised that HIV does cause metabolic changes, so it's not so safe to apply info from PwHIV to people who don't have it. I've been in treatment for 24 years and have a peculiarly fucked up system because of all the drugs. I have, largely through this board turned around from thinking that truvada PrEP is simply a proof of concept, to the point of view that it's a damn good idea, especially when teamed with treatment as protection - about 10% of guys whose VL via blood is undetectable still show detectable in their cum. There's a growing thought that guys on integrase inhibitors such as raltegravir and dolutegravir have a lower incidence of detectability in their cum since the integrase inhibitors seem to be able to reach those places other drugs can't.

Best of luck.

[ffoz]

bearbandit, thanks. i find your comments/thread very interesting to read. )

[Guest JizzDumpWI]

Bbpozboy... Sent you pm as we are both in wisconsin.

not sure what your screen name might be indicating.... But if you are poz you won't get on prep.

[wood]

* Some authorities failed to read a key research report in detail, and are quoting an average efficacy rate. Efficacy for patients who adhered to the drug regimen was above 90%. It stands to reason that drugs only work if we take them.

not quite. The studies so far have shown that PrEP taken on average 4 times a week, has efficacy in the 92-96% range. When taken everyday as it should be, efficacy was estimated at over 99% effective because no one converted in the studies.