Prep In The Uk?

[dude8688]

Just wondering if there are any guys here who have managed to get PrEP prescribed on the NHS? Is it even available yet?

I wanna start but figure going to the GUM Clinic and essentially admitting I can't stop fucking raw is pretty shameless! Is that enough justification to get on it?

[paskin]

AFAIK it is still not available on the NHS... The recent High Court Ruling only said that they have to consider funding it... Pretty sure that hasn't happened yet, though I don't really follow the mainstream news. 

 

I bought mine online from United Pharmacies, very straightforward transaction. All the details and links are available at http://iwantprepnow.co.uk

[HereInLondon]

I can second the recommendation for United Pharmacies.

My order came thru no bother, 12 days after receiving their confirmation email that my order had been dispatched.

[hardix]

Likewise, I got mine online thru United. Still went to the clinic tho to make sure HIV and STI clear before starting on Prep, also needed to get kidney and liver function baseline before starting.

[dude8688]

Well I've got my 3 month post PEP test next month. All being well, that is, neg, I'll probably order my first batch of PrEP.

[lj1987]

Can you just use the Travada for pep as prep? Is it the same drug?

[paskin]

AFAIA it is the same drug, but the dose is slightly different: The Truvada I was given as PEP tablets contain Tenofovir Disoproxil Fumarate: 245mg and Emtricitabine 200mg, compared to the generic PrEP I've been buying (both "Tenvir-EM" by Cipla and "Tavin-EM" by Emcure) which contain 300mg of Tenofovir Disoproxil Fumerate and the same 200mg of Emtricitabine.

i.e. The PEP Truvada contains 55mg less of what I understand to be the main preventative drug, per pill, than you would get in PrEP.

I have no idea whether that is significant enough to make a difference to the protection offered... If you're daily dosing everyday, that would work out at missing just over one pill a week but speculating whether a consistently reduced dose is less effective is best left to others more qualified. One other risk is that an ineffective dose may also make the virus more resilient to Truvada if you do get infected, and consequently affect your treatment.

 

 

[travelingbutthole]

The NHS lost the court case so the next step is going to be 10'000 people on a 3 year long clinical trial.

http://www.bbc.co.uk/news/health-38183672

[rawfuckr]

6 hours ago, travelingbutthole said:

The NHS lost the court case so the next step is going to be 10'000 people on a 3 year long clinical trial.

http://www.bbc.co.uk/news/health-38183672

What does this actually mean? 

Is the NHS simply buying some time until the generics arrive and the cost savings from giving PrEP to people vs HIV infections are real?

[travelingbutthole]

1 hour ago, rawfuckr said:

What does this actually mean? 

Is the NHS simply buying some time until the generics arrive and the cost savings from giving PrEP to people vs HIV infections are real?

If I remember correctly the NHS were arguing that the efficacy of PrEP was unconfirmed and therefore it wasn't cost effective when compared to condoms.

http://www.proud.mrc.ac.uk took up the challenge and ran a trial with 500 participants that ultimately reported an 86% risk reduction.

500 people isn't a large enough sample size to put PrEP on the NHS drug list but it is enough to make The National Institute For Health And Care Excellence, https://www.nice.org.uk, who will run a 3 year trial with 10'000 participants.

If the results hold up then the NHS can negotiate with the manufacturers directly to bring down the price.  This group negotiation process hacks huge chunks of money off the price.  Take my Atripla for example, it costs the NHS £679/$864 for 30 pills compare to $2000-$4000 to the US healthcare system.  PrEP costs about £400/$510 at the moment so just imagine how much more cost effective once the group discount is applied.

The final patent on PrEP expires at the end of 2018 anyway so this the start of a significant process.

As a HIV+ bi man my pool of potential partners in the UK is about 100'000 but in 4 years time a loving and understanding partner who isn't HIV+ is an option.

 

This could be a return to "normality" for so many people and I fucking love it.

Edited December 4, 2016 by travelingbutthole

[rawfuckr]

21 hours ago, travelingbutthole said:

 

500 people isn't a large enough sample size to put PrEP on the NHS drug list but it is enough to make The National Institute For Health And Care Excellence, https://www.nice.org.uk, who will run a 3 year trial with 10'000 participants.

 

I would assume NHS makes their decisions on what drugs to use, in trials done all over, and not just in the UK. There must be lots of drugs which would be impossible to assert efficacy by the UK alone. Thus this argument that NHS needs to 'run their own numbers' to justify cost it's a bit iffy. There have been so many PrEP trials so far that efficacy is beyond any reasonable doubt. 

I'm surpirsed Truvada already only costs $510 in the UK. My script in USA runs at about $1450/month... from which I pay nothing. I'd think the UK could bring the generic price down a lot in a couple of years! And this is why I think the NHS is just dancing around nothing. They could just pay the brand pricing for a couple of years, avoid lots of people getting HIV, and get into a cost effective situation later. Like what France is doing. 

 

And to your last line, yes! PrEP has completely obliberated the HIV+/HIV- divide in the USA. No one cares anymore, because it doesn't matter anymore. Between TASP and PrEP, it's a new world. Myself - I started not thinking about it a couple of years back. But it was a process for me to get to that point. I imagine it will be the same for lots of other people.

Edited December 5, 2016 by rawfuckr

[travelingbutthole]

4 hours ago, rawfuckr said:

I would assume NHS makes their decisions on what drugs to use, in trials done all over, and not just in the UK. There must be lots of drugs which would be impossible to assert efficacy by the UK alone. Thus this argument that NHS needs to 'run their own numbers' to justify cost it's a bit iffy. There have been so many PrEP trials so far that efficacy is beyond any reasonable doubt. 

I'm surpirsed Truvada already only costs $510 in the UK. My script in USA runs at about $1450/month... from which I pay nothing. I'd think the UK could bring the generic price down a lot in a couple of years! And this is why I think the NHS is just dancing around nothing. They could just pay the brand pricing for a couple of years, avoid lots of people getting HIV, and get into a cost effective situation later. Like what France is doing. 

 

And to your last line, yes! PrEP has completely obliberated the HIV+/HIV- divide in the USA. No one cares anymore, because it doesn't matter anymore. Between TASP and PrEP, it's a new world. Myself - I started not thinking about it a couple of years back. But it was a process for me to get to that point. I imagine it will be the same for lots of other people.

I'm sure that they take global trials into consideration but they primarily use the results from NICE and then they perform a cost/benefit comparison.  Giving people PrEP is more cost effective than a life of HIV treatment and the potential health issues that can lead to.

The only problem I can see is if the god bothers start injecting its ancient concept of morality into the discussion.

The lower cost is a function of direct negotiation with the manufacturers.  In 2013 the UK spent a total of 153 billion pounds on healthcare and only 25.5 billion of that was private.

We have a private healthcare system if we want it but the NHS provides the life saving care we need on a non profit basis funded from taxes so all private care is getting you is a private room and a quicker appointment.

The private vs public health care debate is fascinating but I just can't imagine having to pay a monthly insurance fee and still have to pay out of pocket costs.  I know that you don't directly contribute to any of the $1450 price for the PrEP but ultimately someone always has to pay.

Edited December 5, 2016 by travelingbutthole

[sxcj87]

So is the missing 55mg affect the effectiveness of prep? Fuck I have been bred a few times already

[rawfuckr]

On 12/3/2016 at 4:48 PM, paskin said:

AFAIA it is the same drug, but the dose is slightly different: The Truvada I was given as PEP tablets contain Tenofovir Disoproxil Fumarate: 245mg and Emtricitabine 200mg, compared to the generic PrEP I've been buying (both "Tenvir-EM" by Cipla and "Tavin-EM" by Emcure) which contain 300mg of Tenofovir Disoproxil Fumerate and the same 200mg of Emtricitabine.

i.e. The PEP Truvada contains 55mg less of what I understand to be the main preventative drug, per pill, than you would get in PrEP.

I have no idea whether that is significant enough to make a difference to the protection offered... If you're daily dosing everyday, that would work out at missing just over one pill a week but speculating whether a consistently reduced dose is less effective is best left to others more qualified. One other risk is that an ineffective dose may also make the virus more resilient to Truvada if you do get infected, and consequently affect your treatment.

 

 

 

It is exactly the same. US version is 'Tenofovir Disoproxil Fumarate', EU version is 'Tenofovir Disoproxil' which yields different mg counts. The 'tenofovir disoproxil fumarate' is the prodrug in the pill.. your body metabolizes this down to 'tenofovir disoproxil' which the active ingredient. The different in mgs comes from telling which one you are counting, but they are the same compound with same quantities on the pill.

 

From here https://goo.gl/r4RkjU :

 

• Tablet: 200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate (equivalent to 245 mg of tenofovir disoproxil): blue, capsule-shaped, film-coated, debossed with "GILEAD" on one side and with "701" on the other side.

Edited December 6, 2016 by rawfuckr

[paskin]

2 hours ago, rawfuckr said:

 

It is exactly the same. US version is 'Tenofovir Disoproxil Fumarate', EU version is 'Tenofovir Disoproxil' which yields different mg counts. The 'tenofovir disoproxil fumarate' is the prodrug in the pill.. your body metabolizes this down to 'tenofovir disoproxil' which the active ingredient. The different in mgs comes from telling which one you are counting, but they are the same compound with same quantities on the pill.

 

From here https://goo.gl/r4RkjU :

 

• Tablet: 200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate (equivalent to 245 mg of tenofovir disoproxil): blue, capsule-shaped, film-coated, debossed with "GILEAD" on one side and with "701" on the other side.

 

Thank you,  rawfuckr, for clarifying that... and apologies to all for any further confusion that my own confusion and assumption may have caused.

At least we're  now clear that PEP Truvada is equivalent to that prescribed as PrEP, and there's no need to worry about the apparent difference.