doc said no-- next step?

[rawmikeshaw]

Yes, you need to get a new doc. Or your doc needs to get educated.

[Guest JizzDumpWI]

The fact that he would make that kind of statement about possible weakening of Truvada if you did get HIV just shows that he has no idea what he's talking about. A particular strain of HIV can become resistant to a given medication by exposing the strain to the medication and allowing the virus to evolve its way around it. That obviously can't happen if there is no virus in your system.

I'd find another, more knowledgeable doctor. Not everyone who graduates from med school is intelligent enough to be trusted with your health.

Exactly. The issue with just being on Truvada if you convert is that on its own it is an inappropriate HIV drug. Add one more component though and you have Atrypla. This is the reason the US PrEP protocol includes quarterly STI testing.

[mike_thieriot]

Doc is sort of right :-(. You can end up with Truvada-resistant HIV if you're +ve when you start Truvada or if you catch it while you're not taking it properly (and we know that less than 20% bother to take their pills every day, so...).

But that's why you're supposed to have a HIV test when you start and every 3 months after.

I'd still contact My PrEP Experience .. or ask to be referred to a specialist .. I don't think a doctor is obliged to prescribe you something just cos you ask for it or the state intervenes.. that sounds kind of.. un-American?

That is correct, but thats kind of a chicken-and-egg argument. Did whatever strain you caught happen to evolve a resistance very rapidly after infection, or was the already-resistant strain the only one that took because the Truvada killed the rest of the poz loads you took?

edit: My mistake, glanced over the "if you're +ve when you start" thing. Best idea is to use a PCR test for the actual virus before starting, then. Its accurate after only a few days.

Edited January 12, 2014 by mike_thieriot

[hungry4more]

Well, here's a good update- the doctor just called me to apologize! He said he found and read the literature over the weekend, agrees that it's appropriate for me, and had put the prescription in (I had originally went in for some other bloodwork last week that he was able to get my baseline kidney info from). Still got read the official disapproval-- as he put it, "though HIV is the most catastrophic, it's also the least prevalent, and this doesn't protect against anything else." I feel relieved I don't need to battle it out to get the meds. Thanks for all the support, guys.

[Guest JizzDumpWI]

Congrats. You will have to train him. Go for a full STI screen quarterly, and kidney function 45 days from now, at six months and then every six months from then on. He probably does not keep Gilead copay cards. So contact them yourself. That card will pick up copay, making your prescription free.

[spike-the-cat]

This latest development is a good reason to stay with him. To do the research himself, on his own, face his prejudices, and contact you to apologize are signs of a man--and a doctor--of quality. All of us are wrong from time-to-time, especially the first time we are asked to face a new issue. Rather than doubling down, he looked into the available information and changed course. You really can't ask much better than that from a human.

[mike_thieriot]

This latest development is a good reason to stay with him. To do the research himself, on his own, face his prejudices, and contact you to apologize are signs of a man--and a doctor--of quality. All of us are wrong from time-to-time, especially the first time we are asked to face a new issue. Rather than doubling down, he looked into the available information and changed course. You really can't ask much better than that from a human.

This makes me wonder what the doctor actually said. Seems like he may have just been hesitant to prescribe something he hasn't studied thoroughly yet.