Prep And Hiv Vl

[smartass]

Ive been on Proud Study/Prep a year now and everything is good.

I'm mostly passive but I never took loads i..e. never let the guy cum inside me, that was my extra level of protection.  I broke that taboo about 5 months ago, had the a recent checkup and everything is still negative.  The guy that came in me I  suspected was HIV + even though he said he wasn't (his bbrts + other profile = 'ask me', always parties' etc).

The last couple of months I'be been taking loads (letting the guy cum inside) from guys I know are HIV +. I strongly suspect that they could be 'undectable' (long story but good basis for it).

I figured taking loads from Undectatable guys and me being on Prep - was a close to being safe with bb sex as possible (I know nothing is 100% but the risk seems miniscule).

Long story short - met a guy couple of weeks ago at bb sex party, he came in me.  Met again at his place, he came in me multiple times.  He told me he was HIV, was undectable but at same time told me you should believe everything, alot of HIV + guys say they are undect when they are not.  His bbrts states he is Positive (not undect). Although I know he is taking meds, he took them in front of me, I think he has just started on meds.

I'm due to meet him again now, but concerned abit about risk.  I know this is hypothetical, but Im trying to gauge my level of risk.  I never miss a dose (although I have been an hour or two late a few times).  Assumping his VL is high or is dectatable and I'm on prep and taking his loads - how risky is it ?  I appreciate its a 'how long is a piece of string' type question but I'm just trying to quantify it.

 

Is it really true that no-one on prep thats adheres properly to their medication has caught HIV ?

[fillmyholeftl]

It's of very minimal risk... As long as you are being compliant with your meds.  And also there have been no cases of transmission when PReP is taken properly (as directed).  Continue taking the loads you crave.

[bearbandit]

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.

[wood]

It's of very minimal risk... As long as you are being compliant with your meds.  And also there have been no cases of transmission when PReP is taken properly (as directed).  Continue taking the loads you crave.

This is correct (as of right now) 

 

I've been in similar positions, and just had my checkup last week, all good.  However I also had a small freakout moment a few weeks ago.  I got sick with a stomach bug, and then a cough, cold type thing, and I almost NEVER get sick, so in the back of my mind I was worried about HIV, despite never missing a dose like yourself.   

 

One thing about PrEP is that it challenges your way of thinking compared to traditional dogma, and to a certain extent you have to trust in the science.  PrEP works when used as directed because it provides a barrier to HIV that no other method of protection can match.  Historically if you were exposed to HIV, there was a chance of infection.  With PrEP, its the opposite, even with exposure and viral particles in your bloodstream, the virus simply dies.

 

Lastly, getting onto the "detectable, undetectable, negative, unknown, etc" discussion, one of the best parts abut PrEP is that it makes much of those status's irrelevant.  Case in point two guys I fucked within the past year.  One tested poz soon after we fucked, meaning he most likely had a high VL when we had sex, so his "neg on PrEP" status meant nothing (note: PrEP didn't fail, he stopped taking it because of insurance reasons, continued his same activities, and thats all it took)  In another case, A regular FB who is undetectable, stopped taking his meds for about three months due to mental health issues, so he almost certainly wasn't undetectable in that period.  This is the kind of thing that PrEP is perfect protection against.  Their status doesn't matter nearly as much as does you keeping up with your medication.         

[smartass]

Thanks for the replies, it is reassuring.  I guess the bottom line is that we don't know for sure - thats why its a trial - but so far, all the  prep evidence from around the world looks very promising.

It could be that Prep is very effective irrespective of viral load. I know you have to trust the science, take that leap of faith - but its scary when its your life your playing with.

Stick to prep regime,  educate yourself on the risks (based on evidence so far) and decide what risks you are comfortable with.

I'd love to fast forward a couple of years from now, when more data from prep is in.  I'm hoping that well be able to say with confidence that prep is as effective/if not more than condoms.  Imagine how many lives that  will change/save.
 

[rawfuckr]

I'm due to meet him again now, but concerned abit about risk.  I know this is hypothetical, but Im trying to gauge my level of risk.  I never miss a dose (although I have been an hour or two late a few times).  Assumping his VL is high or is dectatable and I'm on prep and taking his loads - how risky is it ?  I appreciate its a 'how long is a piece of string' type question but I'm just trying to quantify it.

 

Is it really true that no-one on prep thats adheres properly to their medication has caught HIV ?

 

There have been a few PrEP breakthrough seroconversion cases, but all involving straight sex and in all of them we can't tell how well their adherence was. There is one particular case of someone who seroconverted with their regular straight partner, and seemed to be taking Truvada regularly because he/she had detectable levels at all meetings of the partners PrEP study. He/she went onto seroconvert AND develop resistance to Truvada. We know he developed resistance due to PrEP because they were able to determined he got infected from the partner through genotyping, and the partner did not have resistant HIV, so resistance happened inside him while taking PrEP.

 

There's a lot to learn still, but PrEP seems to be very effective, specially for bottom gay men. The concentration of Tenofovir in rectal tissue is orders of magnitude greater that in cocks or vaginas so this alone could be a reason why we haven't seen any seroconversions in gay bottoms. It could be that protection is absolute even if you get loads with sky high VLs. We don't know.

 

We do know it is very effective north of 90% with certainty, but can it fail? You are in the absolute highest risk of those who are perfect PrEP adherers having gay sex, so you should really be aware that seroconverting with all we know today and your perfect adherence is still a possibility, specially if you have lots of encounters where you get loaded and most of them seem to be loads with detectable VLs. Only you can answer the question, but how would you life change if you seroconverted? Right now it's a possibility, greatly diminished by your PrEP regimen, but it's there and you should think how you would life change. 

[Guest kazore]

How can tenofovir concentrate in the rectal tissue? I thought that it was in the blood at the same level everywhere in the body.

Also is there any and efficient follow up with regular guys on prep? Are doctors supposed to report to anyone patients who seroconverted?

 

It seems also that some other guys are tested less often than other. 

[rawfuckr]

How can tenofovir concentrate in the rectal tissue? I thought that it was in the blood at the same level everywhere in the body.

Also is there any and efficient follow up with regular guys on prep? Are doctors supposed to report to anyone patients who seroconverted?

 

It seems also that some other guys are tested less often than other. 

 

I don't work in the medical so maybe someone around here can explain further. The tenofovir level in plasma doesn't matter much, where it really matters for PrEP is is in the PBMC cells (http://goo.gl/d4TJqN) which are the ones HIV attacks. You must have sufficient levels of tenofovir inside the CD4 cell to stop the replication process if you were to get infected. While you ingest your daily Truvada pill, tenofovir accumulates in the PBMC cells little by little every day. In the studies they go and take biopsies of tissues to see when maximum concentration levels are achieved. For rectal tissue it happens the fastest, and it's about 5-7 days when it peaks, therefore you get max protection. Other areas, like vaginal tissue take much longer up to 21 days, and even then it never reaches the levels of the rectal areas. I've never seen any mention of levels in the dick. Your intuition is right in the sense that plasma levels of Tenofovir must be pretty much the same all over the body and they saturate pretty quickly, I think in 24 hours or so. What you actually ingest is TDF, which is a prodrug of tenofovir. There's all sort of metabolic hooplas that they have figured out that make it that you end with just tenofovir inside the PBMC which is what you want for treatment and prevention.

 

As far as follow up, the CDC recommends at least screening for STDs every 6 months and continuously check for kidney function. It's just a recommendation and doctors/people will do whatever they see fit. In most states anyone who turns HIV+ must be reported, but I don't think there's nothing specific to if someone is on PrEP or not. 

[drscorpio]

I think the thing smartass is confusing himself with is the belief that condom usage is anywhere near 100% effective in preventing HIV. The best estimates are condoms fail 5-10% of the times they are used, and that assumes that they are being put on correctly. 

 

I have a buddy who converted from being fucked with a rubber. His versatile fuck buddy apparently had a box of out of date condoms that broke way too easily. His buddy had taken a load sometime previously with one of these bad condoms and not noticed the break. Sometime later he fucked my friend, and neither of them noticed the break. It turned out he was at the most infectious point after recently converting and passed it along. This all came to light because my friend had such a powerful fuck flu that they caught his conversion as it was happening. He was feeling very sick, but not testing Poz yet. 

 

PrEP offers a comparable level of protection to a condom, and you are COMPLETELY in control of it. You don't have to depend upon another guy putting on the rubber correctly and making sure it doesn't break. 

[bearbandit]

 

 

PrEP offers a comparable level of protection to a condom, and you are COMPLETELY in control of it. You don't have to depend upon another guy putting on the rubber correctly and making sure it doesn't break. 

&

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...

[wood]

How can tenofovir concentrate in the rectal tissue? I thought that it was in the blood at the same level everywhere in the body.

Also is there any and efficient follow up with regular guys on prep? Are doctors supposed to report to anyone patients who seroconverted?

 

It seems also that some other guys are tested less often than other. 

Easily.  The bioavailability of tenofovir is about 25%, which means roughly 75% is simply excreted through the bowels, this there is a surplus of tenofovir in the GI track and rectum vs another orifice like a vagina where its not an outlet for waste.

 

Tenofovir is processed through the kidneys, but first pass metabolism often misses certain quantities of medication, or nutrients.  In this case only about 25% of tenofovir is processed where it should be, and the rest just gets passed with stool.  However, rectal tissues still absorb a large quantity of nutrients, drugs, etc, and therefore that "extra" tenofovir is present in a very high quantities in rectal tissue. 

[spermy71]

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.

 

Hey guys,

 

Just wondering where you all get your info.  I've been searching the web for this, and can only find the IPREX study results.  PrEP has been out for a while, and I'd love to know where to get the latest about how it's playing out in the real world.

[bearbandit]

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.

[smartass]

Due to be flying out tomorrow to meet german fuckbuddy, who is HIV+. Have a weekend of rampant sex planned, with others joing too.


Had a few niggling symptons this week, been ignoring them.  But took picture with phone today and it doesnt look good.  A  saw a couple of small anal sores, look very much like syphilis.  I know, becuase I caught syphilis last year for first time and was given a shot


He's gonna be ultra pissed when I tell him, 5 star hotels booked etc. He's the type to say dont worry just come over.


I dont want to go now, especially if it is syphilis. Prep gives me good degree of protection, but surely if syphilis is present, the risks of catching HIV increase expotetnially ? Not to say anything of his reckless atittude of not minding.

I'll go  first thing to clinic, before flight and get checked.  If its not syphilis, but I still have small sores, is there a mucher high risk of catching HIV ? Prep provide protection against HIV, is that at the local level or at the 'cell level'?  What I mean is by 'cell level' is that irrespective of how the virus gets into the body, sores, anal, oral - Prep provides the same level of protection ?

I should change my nick to 'dumbass'

Any advice appreciated

[Pitt1988]

I dont mean to be a pessimist smartass but if indeed you have those sores, it would be better for you to forfeit and get treated first; no one really knows much information regarding having an sti and being on prep; this is your chance to be responsible, regardless of what your "poz" buddy wants, my biggest question to you is why on earth is it so important you only want to meet up with poz guys; especially considering the fact that if you have open sores; and they will indeed bleed alittle during sex, what if your poz buddy has hep c? dude that is one serious pain in the butt you do not want to deal with! just read other guys experience with hep c on here and you will see what im talking about, make the best and smartest decision, good luck