PrEP on demand?

[wood]

On 3/6/2018 at 5:02 AM, GermanFucker said:

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.

QFT.

 

Prep on demand in thoery works great, you are going to hoe out, you do your two weeks before and after, and you are good, but this the poster I quted said, many people will thing a couple before, and a couple after will do it, and yes it will provide some protection, but the amount is not well known or studied.  

For example two weeks ago I got a call from a guy that I fucked three weeks prior, and had tested neg 5 weeks prior, what did he say? he tested poz.  He wasnt on PrEP so undoubtedly he had a sky high viral load.  While I am consistent about my PrEP usage, it still scared me.  People in general are fallible, and I dont have that much faith in people taking a drug because of something that exists only in theory.

 

All of the PrEP studies have said that one of the key issues with it is taking it consistently.  So why would that change for on demand dosing when you are not used to it vs consistent usage? 

That also leads to another issue, and thats of comfort.  Take the guy I just fucked who tested poz.  Before I was NEVER worried about him.  he was a complete top, who got tested regularly, even if he wasnt on PrEP.  So If I wasnt on PREP that could lure me into a false sense of security.  Maybe I had just enough pills on me for a big hoe out,but not a quick fuck, and knowing that he is honest and reliable, I fuck him without taking my PREP because its always been okay.  Then without knowing it I just fucked with a very infectious person.  

To me the idea that you can plan out sex completly, and be 100% certain of your actions in a given situation is a bit naive.  People make mistakes and thats what PrEP is there to protect against, but it cant protect you, if you dont take it.        

[wood]

19 hours ago, Leather69 said:

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. 

This is a great reason to use it on demand, but also to realize that you MUST be careful about potential HIV infection because that would mean you would have to take medication everyday.  

With that said, the newer formulation of tenofovir (tenofovier alafilamide) that is used in the current HIV meds has far less liver and kidney side effects than the version used in Truvada (tenofovir disoproxil).  The studies of using the newer version in Prep are currently in progress, but they need to be studied seperatly because tenofovir alafilamide has a much shorter halflife.    

[Guest GoneFishing]

On 3/1/2018 at 2:27 PM, 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. 

let the wheel decide.

https://shar.es/1LuCIM
 

[Guest GoneFishing]

like i’ve said many times over...

prep are training wheels to bliss 

[wood]

Just now, Chargedup said:

like i’ve said many times over...

prep are training wheels to bliss 

You live your life, I will live mine. (probably longer and happier) 

[6811283]

On 3/6/2018 at 12:50 PM, hungry_hole said:

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. 

That last part is rubbish. You don't need to stop having sex for a week just because you missed a dose. Truvada has a long half-life -- it is very "forgiving" of the occasional missed dose. In the PrEP research trials, no one who took at least 4 pills a week was infected. Of course it's best to aim to take your pill every day, but if you happen to miss one or two, don't stress.

[hungry_hole]

On 3/15/2018 at 3:30 PM, 6811283 said:

In the PrEP research trials, no one who took at least 4 pills a week was infected. Of course it's best to aim to take your pill every day, but if you happen to miss one or two, don't stress.

I stopped PrEP and had the appointment with my doctor and we agreed to continue PrEP for short periods of time, which was what I wanted. I don't want to be taking Truvada when I'm not having sex and lately I haven't had the time or opportunities for anon sex which is the way I like it.

My doctor told me to start Truvada 7 days before planning a sex holiday but continue taking it for a month after the last sexual contact. I found a month to be a bit too much but that's what is recommended, I understand. Any opinions on the protocol when stopping Truvada?

[6811283]

3 hours ago, hungry_hole said:

My doctor told me to start Truvada 7 days before planning a sex holiday but continue taking it for a month after the last sexual contact. I found a month to be a bit too much but that's what is recommended, I understand. Any opinions on the protocol when stopping Truvada?

The official recommendation has been to keep taking it for a month after the last possible exposure, but the more recent thinking is that that's probably too conservative. On Demand Prep only requires you to take one pill a day for 2 days after the last sex. That might be enough, but if you want to play it a little safer, you could do 7 days.

[Guest Memphian]

I've never considered anything other that every day dosage.  Never have any problems remembering to take it as I already take BP medicine once a day, fish oil, low dose aspirin, and a multivitamin.  I just added the Truvada to my weekly pill divider with the other stuff. 

Several guys mentioned you should be on PrEP for seven days before your first unprotected fuck.  My doctor gave me no advice on this which in retrospect seems odd.  But I had read enough to know I needed to wait.  I finally decided on 10 days based on some study abstracts.  But as it turned out I didn't wind up getting fucked until after my 11th dose.

 

[hungry_hole]

On 3/20/2018 at 9:09 PM, 6811283 said:

The official recommendation has been to keep taking it for a month after the last possible exposure, but the more recent thinking is that that's probably too conservative.

The issue I have with PrEP is that one has to continue taking it for a month. I find it too long because when I'm on PrEP I'll be more tempted to take loads which means having to wait for another month, during which time it could happen again. If the wait were 7-10 days it would be less likely for that to happen.

 

[z28]

http://www.prepineurope.org/en/faqs/does-prep-work/intermittent-prep/

http://prevenir.anrs.fr

3 pills is all you need. In the Netherlands, it's recommended double first dose.

https://www.prepnu.nl/en/faqs/   on this page you see in english the schedule.

 

[6811283]

13 hours ago, hungry_hole said:

The issue I have with PrEP is that one has to continue taking it for a month. I find it too long because when I'm on PrEP I'll be more tempted to take loads which means having to wait for another month, during which time it could happen again. If the wait were 7-10 days it would be less likely for that to happen.

 

With the more recent evidence about on-demand prep, many doctors now day two days after the last exposure is enough. Personally I'd feel comfortable with a compromise of about 7 days.

[Leather69]

My doc who specialises in the std field says 4 days before to 4 days after in my case... due to kidney cancer I am running on 1 and taking PReP 365 days a year will cause unintended consequences.

I want to live for a while and do a lot more travelling.

[hungry_hole]

On 7/5/2018 at 5:30 AM, 6811283 said:

Personally I'd feel comfortable with a compromise of about 7 days.

This is what I did on my first period I was on PrEP.

I started 10 days before my trip to South America where I was renting an apartment with a sling. I also knew that many of the local young and not so young guys liked older. I was prepared and was glad to have been taking PrEP because I was able to enjoy sex without worrying about every cock that went into my hole.  I stopped 10 days after I came back from my holiday. When I went for my appointment with my Dr. she told me that the protocol called for 30 days after the last sexual contact.

I started my second period of PrEP and I was worrying about those 30 days of PrEP without sex. Most likely the pharmaceutical companies exaggerate the dosages to make more money, protected by the pretext of safety.

 

[6811283]

8 hours ago, hungry_hole said:

i started my second period of PrEP and I was worrying about those 30 days of PrEP without sex. Most likely the pharmaceutical companies exaggerate the dosages to make more money, protected by the pretext of safety.

 

Don't buy into all the conspiracy theories about pharma companies. Yes, they're in it for as much money as they can make, but there are solid scientific reasons behind the conservative recommendations for how to take Prep (until more recent research came along that superseded them). It's not pharma companies who come up with those, and selling another 23 pills (or whatever) by exaggerating the recommendation would be insignificant to their bottom line.