Prep Only Round Possible Exposure?

[LocalGuyTopNL]

In the Netherlands a new research project with PrEP starts soon. They are going to test two forms of taking PrEP and I wonder if anybody has any experience with the second form.

1) Daily PrEp: Every day, with food, 1 tablet Truvada.

2) Intermittent PrEP: Between 24 to 2 hrs before possible exposure, with food, 2 tablets Truvada, after possible exposure 1 tablet Truvada every 24hrs till 48hrs after possible exposure. (I don't know if it's the first pill straight after possible exposure, so 3 after exposure, or 1 after 24 hrs so total 2 pills after exposure)

Since I subscribed for this trial (even though I haven't heard yet if I can participate since there are maximum 370 spots) and the participants can choose themselves which form they choose, I'm really curious if anybody has any experience or thoughts about the 2nd option.

[tallbtm]

If you want to stay HIV negative and you entered the trial to get on PrEP now before it's generally approved for use in the Netherlands, I'd go for Option 1. It is what has been extensively tested and shown to work. Daily dosing (with or without food) is the U.S. standard for using Truvada as PrEP.  

 

If you want to offer your body for science to see if less frequent dosing also works (and you're less concerned with the consequences of possible HIV infection), you could choose Option 2. 

[fskn]

The dose schedule in the second arm of your study is the same as for the Canada-France IPERGAY study. Instead of daily PrEP, the other arm of IPERGAY involved the same episodic dosing, but with a placebo (sugar pill). Also, you study is open-label, which means that you choose which arm you want to be in, and your doctor knows, too. IPERGAY was double-blind, with participants assigned randomly to receive Truvada or placebo, and neither participants nor doctors informed.

Based on another recent study, iPrEx-OLE, you are protected 100% if you choose daily Truvada and take it at least 4 times a week. The recommendation remains daily.

IPERGAY was so successful that the study was "unblinded" (participants were told which arm they had been assigned to) early, and everyone was given Truvada. The risk reduction was 86% under real-world conditions (people having unplanned sex or forgetting to take Truvada as scheduled). Resukts were reported just a few months ago, so this is cutting-edge research.

So, if you can plan your sex life with reasonable certainty, and if you take Truvada as scheduled, you will enjoy near-total protection if you choose episodic dosing.

I heard Dr. Raphael Landovitz from the University of California, Los Angeles speak about this at a conference a few weeks ago. He pointed out that daily routine improves adherence. He had also noticed that IPERGAY participants were taking 4 doses of Truvada in the average week, and thus meeting the threshold established by iPrEx-OLE regardless of their sexual activity. So, he suggested that episodic dosing isn't worth the slight uncertainty it creates.

Edited July 18, 2015 by fskn

[Leather69]

It would be option 1 for me, unless you were fairly sure that sex wasn't going to be on the menu for a few weeks, then you could safely have a short break. 

[LocalGuyTopNL]

There are over 600 people who subscribed and only room for 370 participants. Next week I should hear if I get listed in, then the screening before the actual start can take up to 6 months..

I hoped it would stat soon cause my risk full behavior is getting worse and worse.

I decided that if I get in, I'll go for the first option. If I ever get on PrEP, better safe then sorry, but if it takes so long, it might be too late anyway..

[NLbear]

Good luck. Keep us posted how it goes. But as a top you are less exposed than a bottom.

[tallbtm]

In the meantime, before you get into the study, you could reduce your risk by preferring "Undetectable" guys over those who just think they're HIV-negative based on their last test, whenever that was.  Poz/undetectable guys who are healthy and on their meds and have their viral loads under control are actually much lower risk for HIV transmission than a random guy who really has no idea what his status is at the moment you hook up.  

 

See http://www.aidsmap.com/No-one-with-an-undetectable-viral-load-gay-or-heterosexual-transmits-HIV-in-first-two-years-of-PARTNER-study/page/2832748/ 

[fillmyholeftl]

New studies hint that undetectables are up to 96% (if not actually 100%) less likely to infect a partner

 

http://www.poz.com/articles/HPTN_052_transmission_761_27517.shtml

[discreetmpls]

Option 2 seems a bit silly, to be honest, given that you have to take 2 pills before you think you might have sex, and then 1 per day until 48 hours after sex.  If you are like me, you'd end up taking 5-6 pills a week anyway, and you're at greater risk (even if still low) than if you just take it daily.  If you are on daily PrEP, it becomes part of your routine, and unplanned sex doesn't have to be a concern.

 

I could see option 2 making more sense only in situations where you are primarily monogamous with a partner, and have a few vacations a year where you have 3-ways or open activity.  There's no reason for someone who is sexually active with multiple partners to go option 2, imo.

[LocalGuyTopNL]

Damn.. I didn't get in! Even though they say that probably some people whom subscribed won't participate, I seriously doubt if a hundred will cancel so I'm quite disappointed right now!

Anyone ideas how to get my hands on PrEP here in the Netherlands?

[NLbear]

Sorry to hear that!

I am not sure if you can order it online from the US for instance. Probably not as it requires testing on a regular basis. And probably would be taken by customs. I don't even know if another country within the EU has legalized it. Maybe Google around.