Anyone else on PrEP missing the risk?

[rawTOP]

Lately I've been thinking I sorta miss the trill of the risk that I used to get when I fucked raw. Not that I'm some huge risk junkie, but a little bit of risk is fun. I'm not having a lot of sex lately so I've tapered back to 4 pills a week (Mon, Wed, Fri, Sun). That's still considered to be something like 90% effective. When and if I go to some big sex party I'll go back to daily pills.

I know it may not sound logical, but I like the protection PrEP gives me and simultaneously miss the risk. Anyone else feeling the same way?

[Guest JizzDumpWI]

Don't miss the risk... Love taking all loads and never even think about asking status.

[rawfuckr]

I know it may not sound logical, but I like the protection PrEP gives me and simultaneously miss the risk. Anyone else feeling the same way?

Getting HIV is really no fun at all, so the only thrill I get is the fear of seroconverting, which in my case has no enjoyable component. With PrEP is nice to know there is an extra level of protection and I make damn sure I take those pills every day.

[rawfuckr]

I'm not having a lot of sex lately so I've tapered back to 4 pills a week (Mon, Wed, Fri, Sun). That's still considered to be something like 90% effective

I'm not sure this is the greatest of ideas. If you seroconvert on 4 pills/week you'll most definitely have suboptimal levels of Tenofovir and Emtricitabine that will at that moment be used to fight the virus. If you go on 4 pills/week for a while while seroconverting seems the chances of developing resistance to Tenofovir could be higher which is something you don't really want. Maybe you could increase your frequency of HIV testing to once a month or 2-4 weeks after sex event with a PCR HIV test to make sure you catch your seroconversion ASAP.

[rawTOP]

I'm not sure this is the greatest of ideas. If you seroconvert on 4 pills/week you'll most definitely have suboptimal levels of Tenofovir and Emtricitabine that will at that moment be used to fight the virus. If you go on 4 pills/week for a while while seroconverting seems the chances of developing resistance to Tenofovir could be higher which is something you don't really want. Maybe you could increase your frequency of HIV testing to once a month or 2-4 weeks after sex event with a PCR HIV test to make sure you catch your seroconversion ASAP.

You're missing the point - I take 4 pills/week during times of low risk. The low risk + the 90% PrEP efficacy is "safe enough". We all make risk calculations in daily life (e.g. is it safe to cross the street against the light?). Sex is no different. IMHO, you're being completely paranoid. It's fine if you wanna live your life that way, but I don't want to.

[ripig]

I wonder what happens if they do find a cure or vaccine, seeing some have turned this into a fetish. The thrill of taking poz loads or not knowing what type of loads you'd be taking would be gone.

[Guest JizzDumpWI]

Very true. For me any cum in me is good cum in me. I never feel like "aw crap, it wasn't a poz load". I personally like better not having to focus on a virus when what I crave is cock, cum, and a hot time with another guy. I think a lot of chasers are looking for exactly that... No need to think virus if it is already there. PrEP is exactly the same without the potential complications. I like to think my pal Norman is looking down smiling that I can be a pig and most likely not get HIV.

[Guest JizzDumpWI]

RT, as long as you take Truvada every day for thirty days after a fuck you should be fine. Else why bother at all? PrEP actually can increase your overall risk if you are not following that thirty day rule.

[rawTOP]

RT, as long as you take Truvada every day for thirty days after a fuck you should be fine. Else why bother at all? PrEP actually can increase your overall risk if you are not following that thirty day rule.

I was reading an article that IRMA (the rectal microbicide folks) linked to on their Facebook page. It was an interesting article about the different PrEP adherence rates for different populations and regions. One of the things they said was:

However, [a certain % of people], had levels consistent with taking four doses a week or thereabouts. This dose, while not recommended, has been calculated by the iPrEx study researchers as being about 96% (minimum 90%) effective.

So 4 pills a week is 90-96% effective (theoretically). That's identical to condom use which reduces your risks 10-20 fold.

Now, I realize the theoretical nature of that research, but I'm only doing it when I'm really not having much sex (sex every few weeks). If my risk goes up, I'll "use more protection".

[Guest JizzDumpWI]

Sure, that figure reduces your risk within the parameters you layed out of contracting HIV. BUT, increases your risk should you sero convert. Hence the 30 day AFTER sex rule.

Now, I know you top and don't bottom, so you're already at somewhat reduced risk. Given all the factors, it is probably inconsequential for you whether you do 4 pills a week or 7. But I would not want anyone reading this thread, especially those who bottom, taking a similar approach just cuz RT does it. As site owner, you will influence more behavior than you might realize. Someone who contracts HIV while taking a PrEP regimen and then contracts the virus is putting them at greater risk than if they just contracted HIV with no PrEP at all.

[rawTOP]

Sure, that figure reduces your risk within the parameters you layed out of contracting HIV. BUT, increases your risk should you sero convert. Hence the 30 day AFTER sex rule.

What do you mean increases risk should I sero convert? You mean of drug resistance? I'm OK with that risk.

Now, I know you top and don't bottom, so you're already at somewhat reduced risk.

Actually I'm more vers top these days. Depends on my mood.

[Guest JizzDumpWI]

Yes, exactly on your interpretation of increases the risk. If I were going to follow your path, I would have my ID doc go ahead and do the resistance panel now to identify any ARV's that might be off the table for me. Then I would be informed about how risky drug resistance might be for me in particular.

I know you're OK with that RT, and I'm even interested in knowing how that goes for you. But my stronger point I was trying to make was that I would not recommend others follow your lead just because you do that. I know that PrEP research continues; and that one objective is to get away from daily dosing. A more effective morning after pill (which would technically be PEP) is being studied too.

For a time I was a bit obsessive about time of dosing. If I slept in on a Sunday morning I was unrealistically worried. I've let all of that go. If my Sunday dose is 3 hours later than my normal time; so what? Things are not so specific that 180 minutes are going to make a difference. In the end, you might be spot on, and every other day dosing might be equally effective - more than your assumptions of risk. In conversation with my ID doc, if I miss one dose a month; it isn't going to make a difference good or bad. So there is more leeway in the dosing schedule than FDA subscribes to; no surprise there. But it is a lot easier to gain compliance by telling folks, "take your pill daily at the same time of day". And it is easier to remember.

[jcklvrga]

I think it makes sense to evaluate your own risk avoidance/acceptance levels, and I respect others desires to live with different levels of risk.

I still don't think PrEP makes sense for all of us right now. And, I think there are still some valid medical concerns out there, the use of Truvada for PrEP, and used "incorrectly" by large numbers, can possibly lead to some development of resistant strains.

We all experience all types of risks every day, and part of being alive is living with and yes, sometimes enjoying some selected risks.

[rawTOP]

Yes, exactly on your interpretation of increases the risk. If I were going to follow your path, I would have my ID doc go ahead and do the resistance panel now to identify any ARV's that might be off the table for me. Then I would be informed about how risky drug resistance might be for me in particular.

I still don't think PrEP makes sense for all of us right now. And, I think there are still some valid medical concerns out there, the use of Truvada for PrEP, and used "incorrectly" by large numbers, can possibly lead to some development of resistant strains.

Both of you have a rather fundamental misconception - neg guys cannot be meds resistant. It's the HIV, not the person, that's meds resistant. If you don't have HIV, there's no way to be meds resistant.

For a time I was a bit obsessive about time of dosing. If I slept in on a Sunday morning I was unrealistically worried. I've let all of that go. If my Sunday dose is 3 hours later than my normal time; so what? Things are not so specific that 180 minutes are going to make a difference. In the end, you might be spot on, and every other day dosing might be equally effective - more than your assumptions of risk. In conversation with my ID doc, if I miss one dose a month; it isn't going to make a difference good or bad. So there is more leeway in the dosing schedule than FDA subscribes to; no surprise there. But it is a lot easier to gain compliance by telling folks, "take your pill daily at the same time of day". And it is easier to remember.

Doctors are used to the relationship poz guys have with ARVs. A neg guy's relationship is very different. We're not controlling a virus. We just need a certain level of it in our system when we get exposed to HIV. The reason why you have to take Truvada for 5 days before you're completely covered is because Truvada has a very long half-life. What that means is that you do not have to take it at the same every day - it takes something like 2 weeks for Truvada to leave your system once you stop taking it. You're filling a bathtub with a slow leak at the bottom and you only need it to be 1/2 full.

Relax. You're not poz.

Now, if you just went to a sex party and got 10 loads from random, anonymous guys. Yeah, you should be diligent about taking it every day leading up to and for a few weeks after the party. But if you're just having sex here and there and you know most of your fuck buds and they're generally poz and on meds - relax.

[BiAggieGuy]

Not at all. Have had some of the best sex ever since going on PrEP as I haven't been worrying about status. Poz guys have been some of the most amazing fucks.