How effective is the Intermittent 2-1-1 for PrEP?

[IAcollegeguy]

What are the chances of getting HIV using only the 2-1-1 plan for PrEP (assuming you're bottoming bare and getting bred)? Is it just as effective as taking PrEP daily for HIV prevention? Any recommendations on daily use or intermittent?

 

From what I understand, the intermittent method works by taking 2 pills 2-24 hours before sex, then 1 pill 24 hours after and 1 pill 48 hour after. If you have sex within 7 days of your last sexual encounter doing this you just take 1 pill for 2 days following the encounter. If you have sex after 7 days of your last sexual encounter, double dose and start the process over again. Is that how it works?

[Guest]

That's the method it's being recommended in many European countries for those who don't need (or can't really afford) a daily pill 365 days a year. According to my doctor it's considered to be as reliable as the daily therapy, but some research papers mighr disagree on that. Still I've chosen to trust my doctor who for sure knows more than I do on this subject.

[BootmanLA]

2 hours ago, bluewind said:

That's the method it's being recommended in many European countries for those who don't need (or can't really afford) a daily pill 365 days a year. According to my doctor it's considered to be as reliable as the daily therapy, but some research papers mighr disagree on that. Still I've chosen to trust my doctor who for sure knows more than I do on this subject.

I don't want to dissuade you from following your doctor's advice, but I would caution: there is far, far less margin for error with 2-1-1 than with daily. Any of the following could happen:

--You take the first (double) dose at 10 PM Friday on the assumption you're going to have sex early Saturday evening and you don't want to forget on Saturday afternoon. But then Saturday night rolls around and your partner's not in the mood until midnight or later. 

--You have sex 12 hours after your double dose (good so far!). But then - do you take the second dose 24 hours after the sex, or 24 hours after the first dose? If you choose the first one, it'll be 36 hours between dose 1 and dose 2. Is that okay? Can you remember to find out before the time comes? (Answer: it's 24 hours after the first dose).

--You have sex 8 hours after the double dose, and you plan to take the second dose 16 hours later (total of 24 hours since the first dose). But you have sex twice more in the next few hours, so at the 22 hour mark, you're dozing off because you've been up for so long, and you sleep for 10 hours. Dose missed.

--You're doing well through the first and second doses - right on time. But on the day you're to take the third dose, you get called into work in a rush for a day you were supposed to be off, and in the rush, you forget the pill at home. You don't get to take it until 6 hours after you were supposed to.

And so on and so on. None of those guarantees you're going to get infected (you'd have to be fucked by a poz guy with a load that was not only detectable but enough to overcome the limited protection that "screwed up" 2-1-1 still provides). But it's not as safe as daily.

It's still better than nothing, obviously. It's workable, with more work on your end. But not as protective as daily.

[IAcollegeguy]

Gotcha, thanks for the replies guys I appreciate it 👍

[fillmyholeftl]

On 1/22/2021 at 6:46 PM, IAcollegeguy said:

What are the chances of getting HIV using only the 2-1-1 plan for PrEP (assuming you're bottoming bare and getting bred)? Is it just as effective as taking PrEP daily for HIV prevention? Any recommendations on daily use or intermittent?

 

From what I understand, the intermittent method works by taking 2 pills 2-24 hours before sex, then 1 pill 24 hours after and 1 pill 48 hour after. If you have sex within 7 days of your last sexual encounter doing this you just take 1 pill for 2 days following the encounter. If you have sex after 7 days of your last sexual encounter, double dose and start the process over again. Is that how it works?

Statistically I believe its 83-86% vs ab out 99% for daily.

[Hintyt]

If you try this method, just make sure you have an ample supply of medication with you and/or easily accessible.  There’s always the risk of getting stuck somewhere without those remaining two doses with the clock running out.

[IAcollegeguy]

3 hours ago, fillmyholeftl said:

Statistically I believe its 83-86% vs ab out 99% for daily.

I was actually looking through some old posts on this site mentioning 2-1-1 and found someone who posted this site that digs into the Ipergay PrEP study

[think before following links] https://www.aidsmap.com/news/dec-2015/ipergay-prep-study-results-published

Looks like 86% "reduction in risk of HIV infection" sounds right. Interestingly I guess only 2 people in the experimental group (group that got Truvada) got HIV. But of those two, one didn't even take any Truvada pills during the trial and the other one only took 2 pills total during the trial (meaning they didn't actually do the full 2-1-1 regimen). Which seems to imply that no one in the experimental group got HIV that did the 2-1-1 method properly or properly "enough".

It also looks like 31% of the experimental group took Truvada for eleven days or fewer per month and a little over 50% of took Truvada 15 days per month with no reports of HIV in either group.

[BootmanLA]

On 1/24/2021 at 12:07 PM, IAcollegeguy said:

I was actually looking through some old posts on this site mentioning 2-1-1 and found someone who posted this site that digs into the Ipergay PrEP study

[think before following links] [think before following links] https://www.aidsmap.com/news/dec-2015/ipergay-prep-study-results-published

Looks like 86% "reduction in risk of HIV infection" sounds right. Interestingly I guess only 2 people in the experimental group (group that got Truvada) got HIV. But of those two, one didn't even take any Truvada pills during the trial and the other one only took 2 pills total during the trial (meaning they didn't actually do the full 2-1-1 regimen). Which seems to imply that no one in the experimental group got HIV that did the 2-1-1 method properly or properly "enough".

It also looks like 31% of the experimental group took Truvada for eleven days or fewer per month and a little over 50% of took Truvada 15 days per month with no reports of HIV in either group.

It's also good to remember that some guys who miss doses of PrEP - on either schedule - may not ever actually be at risk. It's not like they line up high viral load tops to test the guys with; they're using largely self-reported data, as in "I took my pre-sex dose on time and the first post-sex dose on time, but I was late for the third dose." They don't test the guy he had sex with - he might be negative, undetectable, detectable but low-risk, or high-risk HVL.

If anything, that would concern me more: if "only" 86% reduction in HIV infection happens with 2-1-1, and that's without knowing if there was even an infectious partner involved, it suggests that if one has a lot of sex with a guy who is NOT undetectable, and you try for 2-1-1 (or use daily but slip up at times), the risk could actually be higher (because you're having unprotected sex with someone known to be capable of infection).

[IAcollegeguy]

@BootmanLA Gotcha, sounds like daily adherence is for sure the safest option. Thank for the reply 👍

[Cutedelicategay]

Doctors in Canada recommend against 2-1-1. According to my doctor who wrote Prep guidelines for Canada, the results are inconclusive. Don't risk yourself if prep is used for the sake of HIV prevention. Not worth the pill after the fact. 

[BootmanLA]

6 hours ago, Cutedelicategay said:

Doctors in Canada recommend against 2-1-1. According to my doctor who wrote Prep guidelines for Canada, the results are inconclusive. Don't risk yourself if prep is used for the sake of HIV prevention. Not worth the pill after the fact. 

I'd agree ONLY with the caveat that if daily is simply not an option - ie you live in a place like the US where access is limited by your insurance company and you're on your parents' policy and they don't know you're gay, much less sexually active - then 2-1-1 is better than nothing at all. But absolutely, if you can - and your doctor and/or pharmacy may be able to help point you to resources that will cover you - then daily is absolutely better.

[IAcollegeguy]

Thanks for the info guys, sounds like daily is for sure the best method then.

[Kimberley]

Intermittent has to many side-effects for me, so i started daily and noticed the side effects where gone in weeks. and i feel safer with it

[Guest]

On 1/22/2021 at 3:46 PM, IAcollegeguy said:

What are the chances of getting HIV using only the 2-1-1 plan for PrEP (assuming you're bottoming bare and getting bred)? Is it just as effective as taking PrEP daily for HIV prevention? Any recommendations on daily use or intermittent?

 

From what I understand, the intermittent method works by taking 2 pills 2-24 hours before sex, then 1 pill 24 hours after and 1 pill 48 hour after. If you have sex within 7 days of your last sexual encounter doing this you just take 1 pill for 2 days following the encounter. If you have sex after 7 days of your last sexual encounter, double dose and start the process over again. Is that how it works?

I only engage in high risk sexual behavior ( getting my ass plowed & taking loads), about every 4 to 6 weeks, on average; I have been doing this for the last 6 years. I was able to get a prescription for prep, through my health care provider a month ago. I stumbled upon this post, and it peaked my interest. Due to some of the side effects, I have read about here, I am thinking of practicing this dosing method

[BiCurious100]

On 1/22/2021 at 11:46 PM, IAcollegeguy said:

What are the chances of getting HIV using only the 2-1-1 plan for PrEP (assuming you're bottoming bare and getting bred)? Is it just as effective as taking PrEP daily for HIV prevention? Any recommendations on daily use or intermittent?

 

From what I understand, the intermittent method works by taking 2 pills 2-24 hours before sex, then 1 pill 24 hours after and 1 pill 48 hour after. If you have sex within 7 days of your last sexual encounter doing this you just take 1 pill for 2 days following the encounter. If you have sex after 7 days of your last sexual encounter, double dose and start the process over again. Is that how it works?

Since I'm hopefully about to go on this 'on-demand' PrEP usage myself, I'm hoping that it's effective...