PrEP on demand?

[hungry_hole]

I took PrEP for 2 months because of a holiday I took at place where I knew I was going to have lots of sex. And I did.

I rented an apartment with a sling and a gloryhole and for several days I had guys coming over at all hours. The guy who rented me the apartment organized a gang-bang for me which was why I was interested in this apartment. Gang-bangs are difficult to organize on your own and also there is the issue of security. It was great! Now that I'm back home and not having much sex I decided to stop PrEP.

I may take another sex holiday and go to a bathhouse. Can I continue with PrEP on demand? That is, take PrEP for 7 days, have sex on a weekend, and continue PrEP for another 7 days after the last sexual contact. Anybody does that?

[fillmyholeftl]

5 minutes ago, hungry_hole said:

I took PrEP for 2 months because of a holiday I took at place where I knew I was going to have lots of sex. And I did.

I rented an apartment with a sling and a gloryhole and for several days I had guys coming over at all hours. The guy who rented me the apartment organized a gang-bang for me which was why I was interested in this apartment. Gang-bangs are difficult to organize on your own and also there is the issue of security. It was great! Now that I'm back home and not having much sex I decided to stop PrEP.

I may take another sex holiday and go to a bathhouse. Can I continue with PrEP on demand? That is, take PrEP for 7 days, have sex on a weekend, and continue PrEP for another 7 days after the last sexual contact. Anybody does that?

You can... It gives you some level of protection, not the approx. 99% that daily PReP provides

[hungry_hole]

On 2/27/2018 at 8:19 AM, fillmyholeftl said:

You can... It gives you some level of protection, not the approx. 99% that daily PReP provides

Why not the 99%?

Let's say I decide to spend just a weekend having sex at bathhouses, sex clubs and adult bookstores If I start taking Truvada 7 days before the first sexual encounter of the weekend and continue taking it for another 7 days after the last fuck of the weekend, shouldn't I get full protection?

Can drug resistance develop from doing this several times?

[fillmyholeftl]

Drug resistance will not develop unless there is a latent (undetected early serioconversion)  Any "on demand" dosing wouldn't statistically give 99% protection.  Theoretically its vary good protection taking as you described.

[leaker30]

Either take it or don't take it. What's the point of taking it when you have sex and not taking it when you don't have sex?

Just take it all the time. 1x a day and then you don't have to worry about it. 

[hungry_hole]

13 hours ago, leaker30 said:

Either take it or don't take it. What's the point of taking it when you have sex and not taking it when you don't have sex?

Just take it all the time. 1x a day and then you don't have to worry about it. 

Although I did not have any side-effects I know that Truvada can affect the kidneys. If I were taking anon loads almost daily like I used to, then I would take PrEP without interruption.

[leaker30]

3 hours ago, hungry_hole said:

Although I did not have any side-effects I know that Truvada can affect the kidneys. If I were taking anon loads almost daily like I used to, then I would take PrEP without interruption.

That's why you go to the doctor every three months. They check liver and kidney functions. Most people don't have a problem. So if yours are working fine, then you have nothing to worry about

[Guest FriendlyBottom]

@hungry_hole:  It's great that you're looking for answers to your questions, but (as you surely know) not everything that guys post in online forums is fully-informed or remotely close to the truth.  If you're getting PreP through your doctor, you're probably going in for quarterly HIV/STD/kidney function tests and I think he/she will be better able to answer your questions.  Here is a link to an article describing how some researchers (back in 2016) made a statement that, based upon research findings and mathematical modeling, there is evidence that at least some non-daily dosing regimens of PreP do provide statistically significant (but not perfect) protection against HIV infection. 

https://www.poz.com/article/can-finally-say-ondemand-prep-really-work

 

[hungry_hole]

44 minutes ago, FriendlyBottom said:

@hungry_hole: If you're getting PreP through your doctor, you're probably going in for quarterly HIV/STD/kidney function tests and I think he/she will be better able to answer your questions. 

I have an appointment with my doctor this month but I wanted to get opinions before I see my doctor. I was prescribed medication for 4 months but I used only 2 months and stopped after my sex-vacation. I'm now having no sex but would like to take another week for another sex-vacation before the middle of the year and would like to use the other two bottles for that holiday.

23 hours ago, leaker30 said:

Either take it or don't take it. What's the point of taking it when you have sex and not taking it when you don't have sex?

I take other medications for which I get blood tests every 6 weeks to make sure liver and kidneys are OK. Which is why I want to avoid taking Truvada and putting more stress on the kidneys.

52 minutes ago, FriendlyBottom said:

Here is a link to an article describing how some researchers (back in 2016) made a statement that, based upon research findings and mathematical modeling, there is evidence that at least some non-daily dosing regimens of PreP do provide statistically significant (but not perfect) protection against HIV infection. 

https://www.poz.com/article/can-finally-say-ondemand-prep-really-work

Thanks for the article. After reading it I realized that the way I want to take PrEP is not really "on demand" more like PEP. I want to follow the protocol indicated by my doctor that I should take Truvada for 7 days before any sexual contact and that I must take it for another 7 days after the last contact. I wanna follow the protocol but just for few days at a time, minimum of 14 days + length of holiday.

 

[GermanFucker]

On 1.3.2018 at 3:07 PM, fillmyholeftl said:

Drug resistance will not develop unless there is a latent (undetected early serioconversion)  Any "on demand" dosing wouldn't statistically give 99% protection.  Theoretically its vary good protection taking as you described.

Most guys understand "on demand" as two pills the day before sex, one pill per day for two days after sex. The problem with that seems to be that at least one of the active substances in Truvada doesn't have enough time to build a sufficent level in the mucosal tissues, thus offering not exactly the same level of protection as daily PrEP. Taking PrEP for seven days before sex should be somewhat better, but a.) this is question for a specialist and b.) general probabilities can not really 100% predict what is right FOR YOU. While the data concerning daily PrEP is very sound, when it comes to intermittend PrEP it is somewhat fuzzy, as many understand it differently and medication adherence varies.

E.g.: Daily PrEP is a safety net, if your adherence is rather average than exceptional. If you forget a dose, you still have enough active substance in your system. This is not the case with the 2+1+1 approach. I know guys who took PrEP on demand, but not diligently and who got pozzed because of that.

As to drug resistance: HIV can only get resistant, if you are infected AND on insufficient treatment. That is why HIV testing is an important part of taking PrEP. If you for example got infected because you forgot to take it regularly, Truvada alone would be insufficient treatment, your meds regime would have to be altered in order to avoide resistance. If you take PrEP diligently enough to avoid infection, there is no HIV in your system that could develop a resistance.

 

[hungry_hole]

3 hours ago, GermanFucker said:

Most guys understand "on demand" as two pills the day before sex, one pill per day for two days after sex.

I understand that the way I suggest using PrEP is not what is usually called "on demand". Because I put myself at risk only for planned periods of time, I want to use PrEP to protect myself for that period of time, whether it's just a weekend or couple of weeks.

6 hours ago, GermanFucker said:

While the data concerning daily PrEP is very sound, when it comes to intermittent PrEP it is somewhat fuzzy, as many understand it differently and medication adherence varies.

...If you forget a dose, you still have enough active substance in your system.

On my last visit when I got the prescription, my doctor warned me about the 7-days prior to sexual contact. She even warned me that if I ever missed a day I should again wait for the 7 days before more sexual contacts. I explicitly asked her about issues with stopping the medication and I think shed gave me the impression that as long as I followed the 7-day protocol, things would be OK.

On my next doctor's visit I will discuss my plan of using PrEP for short periods of time because my preference is a wild weekend/week at the bathhouse. I don't feel comfortable taking Truvada when I know I'm not taking full advantage of it. Plus, although in Canada I don't pay much for PrEP, I feel better saving the government some money. 

Thanks for the feedback.

 

[GermanFucker]

1 hour ago, hungry_hole said:

I understand that the way I suggest using PrEP is not what is usually called "on demand". Because I put myself at risk only for planned periods of time, I want to use PrEP to protect myself for that period of time, whether it's just a weekend or couple of weeks.

On my last visit when I got the prescription, my doctor warned me about the 7-days prior to sexual contact. She even warned me that if I ever missed a day I should again wait for the 7 days before more sexual contacts. I explicitly asked her about issues with stopping the medication and I think shed gave me the impression that as long as I followed the 7-day protocol, things would be OK.

On my next doctor's visit I will discuss my plan of using PrEP for short periods of time because my preference is a wild weekend/week at the bathhouse. I don't feel comfortable taking Truvada when I know I'm not taking full advantage of it. Plus, although in Canada I don't pay much for PrEP, I feel better saving the government some money.

To the best of my knowlegde your doctor's recommendation is scientifically sound - meaning that 7 days sounds like a good timeframe for a reasoble level of active substance (i.e. both emtricitabine AND tenofovir) to build up in your system (bloodstream, different types of mucosal tissue etc.). So your idea is certainly not outrageously unrealistic. 

But neither is leaker's recommendation to just go with one pill a day.

The thing is: your suggestion is certainly better than no PrEP at all and most likely much better than intermittent 2-1-1 PrEP on demand. Whether it is AS good (for you) as daily PrEP realistically is a question you can only answer yourself.

E.g. from personal experience: Adherence is not a problem for me, but I have a - let's say: interesting - circle of friends. Things can happen spontaneously. A twosome can escalate into a two-day fuckfest with 30 guys. Not having to plan my periods of sexual activity in advance is giving me peace of mind.

[hungry_hole]

16 hours ago, GermanFucker said:

Adherence is not a problem for me...

Adherence is not a problem for me either. I was taking the pill exactly at the same time for the two months I was on PrEP.

16 hours ago, GermanFucker said:

...but I have a - let's say: interesting - circle of friends. Things can happen spontaneously. A twosome can escalate into a two-day fuckfest with 30 guys. Not having to plan my periods of sexual activity in advance is giving me peace of mind.

If I were in your situation I would be on the daily PrEP without hesitation.

16 hours ago, GermanFucker said:

The thing is: your suggestion is certainly better than no PrEP at all and most likely much better than intermittent 2-1-1 PrEP on demand. Whether it is AS good (for you) as daily PrEP realistically is a question you can only answer yourself.

I'm not sure what you mean because if I follow the 7-day protocol during the periods I'm having sex the protection should be the same as taking Truvada every day. This is what I'll ask my doctor.

[Leather69]

I can't take it daily as I had a kidney removed (cancer). My GP who is a leader in the field of std/hiv advice says to take it for 7 days before and 7 day after an event  say folsom weekends in Berlin. I top only.

As others on here have said.. get your tests done every 3 months.. a good doctor will pick up any problems as these drugs can have side effects. 

[Rillion]

When I was first prescribed PREP the doctor told me that I could take breaks from it if I wasn't having any sex I was concerned about.  His recommendation was to resume taking it at least 5 days before resuming sexual activity.