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Author Topic: truvada alone for PEP?  (Read 8966 times)

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Offline jaf

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truvada alone for PEP?
« on: August 03, 2012, 07:57:04 AM »
Hello;

I had receptive anal sex, and the condom broke.  The guy claimed to have ejaculated twice inside me, and also informed me he was HIV+.

I went to the sex-health clinic the following day.  Initially they refused to help me, as they reserve PEP for rape and occupational accidents, not for consensual sex, claiming lack of funds, but I argued my case and refused to leave. 

Eventually they gave in to my request, and was started on a 28 day Truvada regime, around 26 hours after the incident.

Is Truvada alone enough? What are my chances of avoiding infection? It's been five days since the incident, would starting with Kaletra now (in the event they can provide it) have any effect?   

Offline Andy Velez

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Re: truvada alone for PEP?
« Reply #1 on: August 03, 2012, 08:34:21 AM »
You did the right thing by going for PEP. And you began it early enough for it to be effective. Truvada is often given in combination with Kaletra. If you can get it from a doctor that would be a good idea.

Keep in mind that you can't get a conclusive negative result until 3 months AFTER the completion of your PEP regimen. You can test initially at 6 weeks after the completion of PEP. If you get a negative result then the likelihood is that you will continue to test negative.

Do you know if the other guy is on HIV meds? If he is, then the likelihood is his viral load would be low and that's a factor against transmission occuring. Also, this was a single incident, which also works in your favor.

Keep on with your regimen. It has a good history of working well. 
« Last Edit: August 03, 2012, 08:38:52 AM by Andy Velez »
Andy Velez

Offline jaf

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Re: truvada alone for PEP?
« Reply #2 on: August 03, 2012, 09:25:46 AM »
thanks,

I am going to try and get Kaletra.

Question: How does it being a single incident make a difference? Does HIV transmission require several different incidents of exposure?

Offline Andy Velez

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Re: truvada alone for PEP?
« Reply #3 on: August 03, 2012, 12:25:46 PM »
Repeatedly risky incidents just raise the number of possibilities of transmission.
Andy Velez

Offline jaf

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Re: truvada alone for PEP?
« Reply #4 on: August 03, 2012, 03:47:09 PM »
I don't think I am going to be able to get Kaletra.

The HIV hotline told me that Truvada alone for PEP was common practice.


Offline Andy Velez

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Re: truvada alone for PEP?
« Reply #5 on: August 03, 2012, 04:20:48 PM »
Yes, often given alone.

With only a single risky incident and having begun the med early enough the odds are in your favor against transmission having occured.

Meantime avoid getting crazy about this and focus your attention on other things in your life. It will make the waiting time pass more easily than you may imagine is possible.

Good luck and keep us posted.
Andy Velez

Offline jaf

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Re: truvada alone for PEP?
« Reply #6 on: August 03, 2012, 04:30:54 PM »
OK

I'll let you know when the test results are in.

Meanwhile, good thing is that I don't feel any kind of side effects, nothing at all.

Offline Andy Velez

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Re: truvada alone for PEP?
« Reply #7 on: August 03, 2012, 05:03:39 PM »
OK.

That's excellent about no side effects thus far. Keep going...
Andy Velez

Offline Ann

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Re: truvada alone for PEP?
« Reply #8 on: August 04, 2012, 05:10:55 AM »
jaf,

Truvada is an effective PEP regimen. When Kaletra is added, some people can experience side-effects such as diarrhea and nausea and that can cause people to cease PEP when they really shouldn't. As you were the recipient of anal intercourse and he came, you are one of those who shouldn't stop.

Saying that, provided you keep taking your Truvada every day, chances are excellent that you'll be just fine where hiv is concerned. I'm glad to hear you stuck to your guns until they gave you something. Contrast your experience with people who have had NO risk and get prescribed PEP no problem - it's frustrating to watch. Any recipient of unprotected intercourse should be given PEP without question. Tops and other situations are different.

I'm going to give you some in-depth condom information for future reference. A correctly used condom rarely breaks.

There are two main causes of condom breakage. Listen up - when you're bottoming you are at a much higher risk when a condom breaks than when it happens while you're topping.

One is not using enough water-based lube. Not using enough (or any) lube allows for friction that may break the condom. Do NOT use oil-based lubes such as Crisco, hand creams or other moisturisers that may be handy bedside. Use plenty of spit if you don't have water-based lube. It's better than nothing.

The other main cause is having an air bubble in the tip. When putting a condom on, you need to pinch the tip between the finger and thumb of one hand, while rolling it down with the other. Pinching is VERY important if you're using reservoir tip condoms.

Once it's on, give it a firm stroke from tip to base while watching the tip. If there is air in the tip, you'll see it. If there IS air in the tip, roll it back up and try again. This is what I call the "stroke test".

If it's dark and you can't see the tip well when you do the stroke test, when you get to the bottom of the stroke, keep a firm grip of the condom and penis at the base and feel the tip with your other hand.

If there IS air present, you'll feel the bubble making the tip stand slightly up and away from the head of the penis. If there IS NO air, the tip will be sucked up tight against the head of the penis. You may feel extra condom material if it's a reservoir tip, but it will be standing up if there's air in it.

Once you're sure there is no air bubble in the tip, apply plenty of water-based lube (or spit) and go for it.

When you're bottoming, you can put the condom on your top to make sure it's on correctly and with no air inside. Even if your top puts the condom on himself, you can still give him the stroke test before you let him enter you. I would strongly advise you to do it every time.

I would also advise you that when you bottom, you reach down periodically to make sure the condom is still on your top. Any time you change positions, have a quick look or feel to make sure the condom is still on him and intact (not broken).

You can use the opportunity to also put more lube on him if needed. Keep in mind that you are far more likely than your top is to know when more lube is needed. If the only lube available is saliva (better than nothing and better than something oil-based) USE YOUR OWN to make sure you are well lubed (not for any fear of hiv). Just spit on your fingers and wipe it on your bottom.

For the record, I follow the instructions I've given you every time I bottom - which is every time, being a woman. The ONLY time I ever had a condom break was once when I neglected to do the stroke test. (And no, he didn't get infected.) 

Hang in there. You started PEP in a timely fashion and your chances are good that you'll ultimately test negative. Keep taking your Truvada! Take it at the same time every day and fit it into a routine you do at roughly the same time - like making coffee when you get up in the morning.

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

Offline jaf

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Re: truvada alone for PEP?
« Reply #9 on: August 10, 2012, 04:27:49 PM »
it's comforting to read Truvada is effective by itself.  I read about an experiment with Macaques, where only one of the two components of Truvada, tenofivir, was used as PEP, being 100% effective if taken within 24 hours, but completely ineffective if taken at 36 (somewhere else I read 36 hours was the limit of effectiveness for that drug).  So I suppose having begun to take it at 26 hours, being consistent with the regime, and having another component involved does suggest I will be able to avoid infection. 

Pertaining side effects:  I have experienced soft stools, but not diarrhea.  Other possible side effects (brief episodes of mild headaches, some tiredness) could be due to other causes, since a week before the 'accident' I had just experienced a severe cold which has left a severe chronic cough.  So in all I am feeling quite well, and even if I wasn't I wouldn't quite the regime. 

As for 'sticking to my guns': that has been one positive aspect of the experience - I have become since then much more self-confident and aggressive, as I saw how refusing to give up and fighting for my life can effect the responses of others (the health officials made an exception with me, as they have precise instructions not to respond to such demands, deeming that consensual sex makes such accidents the responsibility of the affected) - convincing complete strangers to go against the law and give me $1,000 in pills does feel like an achievement.... 

Offline Ann

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  • It just is, OK?
    • Num is sum qui mentiar tibi?
Re: truvada alone for PEP?
« Reply #10 on: August 11, 2012, 05:27:52 AM »

As for 'sticking to my guns': that has been one positive aspect of the experience - I have become since then much more self-confident and aggressive, as I saw how refusing to give up and fighting for my life can effect the responses of others (the health officials made an exception with me, as they have precise instructions not to respond to such demands, deeming that consensual sex makes such accidents the responsibility of the affected) - convincing complete strangers to go against the law and give me $1,000 in pills does feel like an achievement.... 


Wow! Talk about false economy! Somebody in your area needs to explain to your local health officials that when there has been an actual risk, the initiation of PEP - expensive as it may be - will save hundreds of  thousands of dollars in the long-run when it prevents that person from becoming hiv positive.

"Deeming that consensual sex makes such accidents the responsibility of the affected" is nothing more than a discriminatory blaming of the victim. Shit happens and sometimes condoms break. This policy is highly irresponsible from a public health point of view and even from a moral point of view. It's no different to denying prenatal medical care to a pregnant woman - a pregnancy can also be the result of an accident during consensual sex. I have to wonder if you're living in the Bible Belt.

While I hate it when I hear of PEP being given out willy-nilly to people with NO RISK situations, I hate it even more when PEP is refused to people who actually have had a risk.

I would suggest that if you have the time and the wherewithal to make a difference where you live, get in touch with a local ASO and offer to help campaign against this terrible and discriminatory health policy. You can find an ASO (aids service organisation) near you by putting your zip code into poz.com's Health Services Directory. I hope you use your experience to make a difference for the greater good.

Ok, I'll get off my soapbox now. I can only hope you hop up on it in my place.

You started the Truvada in a timely fashion and there's no reason to think it won't be effective. Just keep taking it every day. The side effects you report don't sound like any normally associated with Truvada and even if they are, they're mild. Hang in there - you can do it.

Ann
Condoms are a girl's best friend

Condom and Lube Info  



"...health will finally be seen not as a blessing to be wished for, but as a human right to be fought for." Kofi Annan

Nymphomaniac: a woman as obsessed with sex as an average man. Mignon McLaughlin

HIV is certainly character-building. It's made me see all of the shallow things we cling to, like ego and vanity. Of course, I'd rather have a few more T-cells and a little less character. Randy Shilts

 


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