So I messed up my schedule

[briefbouy]

So I was supposed to go for my 3 month check up in December and totally forgot about it (but I didn’t get a call to remind me either-but that’s not my ?)

I called and I contacted my Clinic and I was sent immediately to get tested and give blood samples - the whole 9 yards, and I’m supposed to follow up tomorrow regarding getting back on my PrEP bc I’m out! (I know everything will be negative). If I resume my meds next week - will I be safe to engage in unprotected sex in 2 weeks in Puerto Vallarta. Or do I have to take it longer to have “more” protection in my system???

[fskn]

Your first resource for any PrEP question should be your medical provider. That person is licensed, knows you, is paid to give you medical advice, and has an ethical obligation to you. If your provider isn't available to answer your questions, or if you are afraid to ask, then it may be time to find a better provider!

Three PrEP products are now approved in the US, Truvada (daily or intermittent pill; generic versions made by Teva or Aurobindo also approved), Descovy (daily pill) and Apretude (2-month injection).

Assuming you use either Truvada or Descovy, here is the official word from the CDC's 2021 PrEP guidelines:

"Data from exploratory [Truvada] pharmacokinetic studies suggest that maximum intracellular concentrations of TFV-DP, the active form of tenofovir, are reached in blood PMBCs after approximately 7 days of daily oral dosing, in rectal tissue at approximately 7 days, and in cervicovaginal tissues at approximately 20 days.

"[Descovy] pharmacokinetic study data related to potential time to tissue-specific maximum concentrations are not yet available, so the time from initiation of daily [Descovy] for PrEP to maximal tissue protection from HIV infection is not known.

"Data is not available for either [Truvada] or [Descovy] PrEP in penile tissues susceptible to HIV infection to inform considerations of time to protection for male insertive sex partners."

Also note that if you use Truvada (not Descovy, at this time) and you and your provider have agreed on intermittent/"2-1-1" dosing (in accordance with the CDC's 2021 PrEP guidelines), then starting with the 2 Truvada pills 24 to 2 hours before sex is considered adequate.

Last but not least, more than any other safety check before you resume PrEP, please be sure that you are still HIV-negative, as demonstrated by a 4th-generation HIV antibody+P24 antigen test (or a qualitative HIV viral load test, if your provider is really sophisticated). Some providers still use prior-generation HIV antibody tests, which don't give positive results until months after a person has been infected with HIV.

Being sure that you are still HIV-negative is crucial because PrEP is sufficient to prevent but not to treat an HIV infection. Truvada and Descovy each contain two drugs, whereas an HIV treatment regimen usually involves three (possibly in a single pill). Apretude contains 1 drug given every 2 months, whereas the existing injectable HIV treatment regimen involves 2 drugs, given every 1 month.

The 2021 guidelines and lots of other information are available here (although, once again, the onus is on your medical provider to interpret this material for you):

[think before following links] [think before following links] https://www.cdc.gov/hiv/clinicians/prevention/prep.html

Edited February 11, 2022 by fskn
Mentioned Truvada generics

[hntnhole]

Thanks, fskn, for that clear and valuable information: I'm sure all of us appreciate it.

[hntnhole]

7 hours ago, briefbouy said:

in Puerto Vallarta.

briefbuoy:  I don't know when you were last there, but it's a bit different than it was; a lot more criminal activity now.  Blue Chairs is (or was) a great gay resort on the beach, and I very much hope you get a chance to go to Mauricio's restaurant (you'll have to take a cab - it's rather far away), but it was a fantastic restaurant.  Those Hispanic boys are hotttttt !!!  I'd enjoy reading your "reviews" when you get back. 😈

[fskn]

2 hours ago, hntnhole said:

Thanks, fskn, for that clear and valuable information: I'm sure all of us appreciate it.

My pleasure. Also, the morning after I wrote it, I hope my post doesn't come off as preachy. It was meant to come off as angry — not at @briefbouy, who asks a very good question that many PrEP users are curious about and that has even come up here in BZ before, but at medical providers who leave their patients with questions like this.

Edited February 11, 2022 by fskn

[BootmanLA]

14 hours ago, briefbouy said:

So I was supposed to go for my 3 month check up in December and totally forgot about it (but I didn’t get a call to remind me either-but that’s not my ?)

I know it wasn't your question, but it's worth addressing.

First, you now know this provider (whether it's a specialty doctor or your primary care physician) can't be relied on to nag you to come in for a refill consult appointment. Perhaps they should, perhaps they don't view it as their responsibility, but in the "it is what it is" camp, assume they're not going to. Your choices (going forward) are: find a new primary care provider that is better at notifying you (which can be a crapshoot), or utilize technology to keep yourself updated. On the day of your medical appointment, either make the next appointment (for 90 days out), or at a minimum, ask them how much lead time, typically, you need for getting a non-emergency appointment. If it's two weeks, set a reminder on your phone for THREE weeks ahead of the ninety-day mark. Set a second reminder at the two week mark, in case you dismiss the first one and then forget.

My own doctor always makes the next appointment before I leave his office for the current one, and they're very good at automated email notifications to get lab work done, etc. beforehand. Not all practices are good about that, however.

[timfreo]

2 weeks on prep will be enough

[PozBearWI]

5 hours ago, BootmanLA said:

I know it wasn't your question, but it's worth addressing.

First, you now know this provider (whether it's a specialty doctor or your primary care physician) can't be relied on to nag you to come in for a refill consult appointment. Perhaps they should, perhaps they don't view it as their responsibility, but in the "it is what it is" camp, assume they're not going to. Your choices (going forward) are: find a new primary care provider that is better at notifying you (which can be a crapshoot), or utilize technology to keep yourself updated. On the day of your medical appointment, either make the next appointment (for 90 days out), or at a minimum, ask them how much lead time, typically, you need for getting a non-emergency appointment. If it's two weeks, set a reminder on your phone for THREE weeks ahead of the ninety-day mark. Set a second reminder at the two week mark, in case you dismiss the first one and then forget.

My own doctor always makes the next appointment before I leave his office for the current one, and they're very good at automated email notifications to get lab work done, etc. beforehand. Not all practices are good about that, however.

I certainly agree that a responsible provider will do as you suggest @BootmanLA.  However, it is equally true that each of us is responsible for our own health and should not need mommy to remind us.  A responsible patient will make sure the follow-up appointment is set if the provider (or the providers office person) doesn't.  

[briefbouy]

Thank you fskn for the very polite reply - I never took it as preachy or belligerent!

So, having said that, I’ve switched Primary Physicians and I have been consistent in making my appointments and taking my meds as suggested.

While in Puerto Vallarta I had a blast…literally and figuratively: I had sex daily from lots of locals and vacationers! (Still on PrEp and negative).
 

Although their Bathhouse had been “temporarily” closed, there was absolutely no shortage of men for me to get VERY naughty with! Also, no presence of anything gang or “Mexican Mafia” related was witnessed by myself - I would still recommend anybody to go just to relax or have sex - the place is still a fantastic tropical retreat!

 

 

[hntnhole]

4 hours ago, briefbouy said:

Also, no presence of anything gang or “Mexican Mafia” related was witnessed by myself

VERY please to know that ... I'd heard from friends that it was getting dicey these last couple of years, and I'm glad you had a great time.  

[fskn]

9 hours ago, briefbouy said:

Thank you fskn for the very polite reply - I never took it as preachy or belligerent!

So, having said that, I’ve switched Primary Physicians and I have been consistent in making my appointments and taking my meds as suggested.

This news makes me really happy, @briefbouy. It sounds as if you have found a great new doctor.

9 hours ago, briefbouy said:

While in Puerto Vallarta I had a blast…literally and figuratively: I had sex daily from lots of locals and vacationers! (Still on PrEp and negative).

Sounds like a dream vacation! Out of curiosity, where are you planning to travel next? 😉

[hntnhole]

Read and learn, boys ..... There's a very talented practitioner of the seductive arts afoot ....

<<<grinnnnn>>>

[briefbouy]

9 hours ago, fskn said:

This news makes me really happy, @briefbouy. It sounds as if you have found a great new doctor.

Sounds like a dream vacation! Out of curiosity, where are you planning to travel next? 😉

My next vacay will be in Provincetown in August. 

[Opensesame]

1 hour ago, briefbouy said:

My next vacay will be in Provincetown in August. 

 Cum in July for Bearweek 😉

[briefbouy]

As I run in Spartan Races (if you don’t know - it’s like a giant obstacle course with varying race lengths and # of Obstacles). I will be in Palmerton, PA competing for the first weekend of Bear week…if you known anyone that’s done one, ask them how they feel after running one? Many of them are brutal (yes I’m Masochistic, this will be my 4th Trifecta).

having said all that I will have a look at bookings in PTown for the full week after - granted I don’t get hurt - and I’ll see what’s available…. 
Lots of friends have gone and they share their stories of daytime pool parties and the after parties - after some time at the Dick Dock to get pre-lubed for said after parties!!!