Can I use my PEP regimen as a PrEP regimen?

[Collegekid15]

So, I recently had my first bareback experience yesterday. It was (unfortunately) probably one of the best experiences I've ever had in my life. The guy I slept with was a government official, so chances are he's clean, but I decided to get PEP this morning (first dose 17 hours after exposure) just to be sure. Anyways, when I got my prescription, I saw Truvada as one of the drugs on my regimen, and I immediately started recounting studies going on about using this drug as a preventative agent a couple of years ago prior to freshman year of college. Doing some more research, I see that this drug is upwards to 99%-100% effective in preventing HIV, assuming the drug is taken consistently. I know the day that I get off of PEP, I will for sure be starting on Truvada long term. My question is, can I use the Truvada on my PEP regimen the same as if it were a PrEP regimen? The dosages are the same. The only thing I would be concerned with would be the Isentress medication in which the Truvada has been combined with. Since it is also an AVR, I can't see it diminishing the effects of Truvada, only strengthening it, but I could be wrong.

So pretty much I'm asking if it is okay for me to contact the government official again and ask for a redo? I'm in my slutty experimental phase (which I'm sure you have all been in as college sophomores), so please, just advice, no judging.

[Collegekid15]

Since I'm a math major, I have to throw this in:

Looking at the scientific data, statistically speaking, Truvada PrEP is more effective than condom usage. This is, of course, not taking into consideration the relative age of this drug in comparison to condoms. But, data is data.

[Collegekid15]

So, I recently had my first bareback experience yesterday. It was (unfortunately) probably one of the best experiences I've ever had in my life. The guy I slept with was a government official, so chances are he's clean, but I decided to get PEP this morning (first dose 17 hours after exposure) just to be sure. Anyways, when I got my prescription, I saw Truvada as one of the drugs on my regimen, and I immediately started recounting studies going on about using this drug as a preventative agent a couple of years ago prior to freshman year of college. Doing some more research, I see that this drug is upwards to nearly 100% effective in preventing HIV, assuming the drug is taken consistently. I know the day that I get off of PEP, I will for sure be starting on Truvada long term. My question is, can I use the Truvada on my PEP regimen the same as if it were a PrEP regimen? The dosages are the same. The only thing I would be concerned with would be the Isentress medication in which the Truvada has been combined with. Since it is also an AVR, I can't see it diminishing the effects of Truvada, only strengthening it, but I could be wrong.

So pretty much I'm asking if it is okay for me to contact the government official again and ask for a redo? I'm in my slutty experimental phase (which I'm sure you have all been in as college sophomores), so please, just advice, no judging.

[Jeff G]

Referring to a HIV negative person as clean is to infer that those of that are living with HIV are dirty , its beyond offensive .

I know doctors , lawyers and even government official that's HIV positive and we all got HIV the same way and that was assuming we were having sex with a HIV negative person .

I'm going to leave most of your questions to the other moderators to answer but I will say PEP , Prep or not you are still assuming a risk when you have unprotected sex .

You have had a risk for HIV and will need to test for HIV at 6 weeks post PEP and again at 3 months to confirm the results . You also need a full STD panel done to test for other STD's that can linger without symptoms while damaging you body and mental faculty's .

If you choose to go on Truvada for Prep you will need to have your Kidney and Liver panel labs done at least twice a year and other test to make sure your bones are not becoming brittle leaving you susceptible to fractures and tooth loss . You will need to watch out for numbness and shooting pain in your feet or arms , that's another side effect of long term use of HIV meds , its called neuropathy and its basically nerve damage . The nerve damage can be treated with drugs with their own long list of side effects or you could just take narcotic pain relievers for the moderate to severe pain .

Or you could just use a condom .     

[jkinatl2]

Well, Truvada is indeed effective as PrEP.

I am assuming the unprotected sex you are having is receptive anal sex.

In this case, you are indeed very well protected, though studies are still debating whether PrEP is better than condoms for preventing HIV. And obviously, if you contract another STD your inflammation levels might be off the roof, making your body more susceptible to HIV infection (especially if your partner has a high viral load).

But I have long predicted that chemical protection against HIV would someday surpass barrier protection. And I don't think anyone here is going to try to present condoms as feeling better in receptive anal sex than bareback sex. It's not. Latex causes friction, and even regular application of lubricant won't totally defeat that problem (unless the insertive partner is rather quick on the trigger).

If you can afford it, remember to take it consistently, and so long as you are aware that there are other, fairly scary STDs out there that can change the odds of HIV infection (syphilis, treatment - resistant gonorrhea and chlamydia to name a couple) then making an informed choice to use PrEP is not an unwise one.

You should also be aware of the side effects that can accompany Truvada, both in the long and short term. As Moderator Jeff pointed out, you need to keep your liver and kidney levels monitored. Bone density issues and the chance of neuropathy are also on the menu. Luckily, Truvada is being reformulated to be gentler on the body. Hopefully soon those issues will be far more rare than they currently are.

Your risk here is, and will be low but not zero. But then again, that's science.

[RapidRod]

The guidelines for prep are medication in conjunction with condoms.

[jkinatl2]

The guidelines for prep are medication in conjunction with condoms.

True, but we all know people are not going to do that and, as a moderator in this forum, I refuse to give Cover Your Ass risk assessment rather than discuss the actualities of HIV infection and transmission.

Otherwise we would be cautioning people against "prolonged french kissing," for goddess' sake. And forget about what we day about oral sex, even cunnilingus. I think we went off "script" about a decade ago here.


*Modified for clarification.

[RapidRod]

We don't hold their hands and can't force them to wear condoms but giving the actual guidelines is better than opinions. "For some individuals at very high risk for sexual exposure to HIV, PrEP may represent a much-needed additional prevention method — but it will not be right for everyone. PrEP is an intensive approach that requires strict adherence to daily medication and regular HIV testing. It is not intended to be used in isolation, but rather in combination with other HIV prevention methods. If it is used effectively and by persons at very high risk, PrEP may play a role in helping to reduce the number of new HIV infections in the United States.

[Ann]

For the record, I'm in agreement with Rodney.

Truvada as PrEP alone (without condoms) as hiv prevention should only ever be considered as an option in the context of a mutually monogamous relationship where neither partner has any other active STIs.

Relying on PrEP alone - without condoms - when one is barebacking outside of a mutually monogamous relationship is foolish and just asking for trouble.

It must also be said that it is VERY important to take the Truvada daily, without missing doses, for it to be effective. It should also be taken for a minimum of two weeks before it is relied on at all.

Ann

[Jeff G]

For the record, I'm in agreement with Rodney.

Truvada as PrEP alone (without condoms) as hiv prevention should only ever be considered as an option in the context of a mutually monogamous relationship where neither partner has any other active STIs.

Relying on PrEP alone - without condoms - when one is barebacking outside of a mutually monogamous relationship is foolish and just asking for trouble.

It must also be said that it is VERY important to take the Truvada daily, without missing doses, for it to be effective. It should also be taken for a minimum of two weeks before it is relied on at all.

Ann

I agree with Ann and Rod . I can not endorse the use of Prep without condoms outside of a monogamous  relationship and I'm glad we have the opportunity to make the distinction between sero discordant relationships Vs bare-backing with people of unknown status HIV and the possible presence of other Std's . 

[jkinatl2]

I am sorry if it came across as Endorsing the concept. Outside a mutually monogamous relationship, The chance for an STD related inflammation to cause a surge in viral load, particularly seminal viral load, not only exists but has been documented.

I don't recall whether I have written as much on this particular forum, but I have written about this in depth on this site as a whole.

Within the context of a mutually monogamous Seridiscordant relationship it is indeed possible to use this as a form of safer sex. For random hookups, Studies simply have not been done. The studies which have been done, have been far from conclusive insofar is the true safety is concerned.

I am, however, aware that people are going to use this as a form of safer sex, whether or not it's as safe as they think. I totally agree that there are far too many variables to endorse it. But I have to stop short of condemning it out right when it seems like the alternative to simply be sex without condoms and no other protection whatsoever.

This is one weapon in an arsenal against HIV infection. A relatively new concept, and certainly a controversial one. My perspective, and I apologize if I did not communicate this clearly, is that it's better than nothing. I personally believe that the use of PrEP and a condom seems to be a bit overkill, when a condom alone has proven more than effective in preventing HIV infection.

It is certainly a risk greater than condoms alone In the context of non monogamous relationships. It is a greater  HIV risk risk, I believe, to imagine someone who experiences condom fatigue and has no other alternative.

Again, I apologize if I was unclear.