Biktarvy as PrEP and PEP

[wangancheng]

Although Biktarvy hasn’t been approved to be used as PrEP or PEP, at least in China, I have been recommended here in China to take it as a prevention drug, both as PrEP and PEP, since Biktarvy is literally Descovy plus one more ingredient (BIK). Here I have some questions about how to take it and hope to get some answers. My sexual behavior is MSM insertive anal.

If I start taking Biktarvy as PEP, what should I do during the first 28 days if I have exposure to HIV again? My understanding is that I can stop taking  Biktarvy on (1) the last day of this 28 days’ period and (2) two days after the last HIV exposure, whichever day is later. Or does it have to be 28 days after the last exposure?

For example, if a high risk exposure occurs again on the 16th day of the 28-day PEP drug period but with no further high risk exposure occurs since then, then in fact, it is only necessary to take Biktarvy until the 28th day from the first high risk exposure. The reason is that Biktarvy should theoretically also be used as PrEP, and in this high risk exposure that occurs on the 16th day, since sufficient dose of Biktarvy has already been taken, it should be enough to prevent the risk of infection if the next 12 days of dosage is properly taken. However, if the high-risk exposure occurs on Day 28, then at least two more days of Biktarvy dose has to be taken to avoid being infected, according to the principle of on-demand PrEP administration. I don't know if I understand is correct. Looking forward to getting reply!

Understand that Biktarvy might not have been approved or recommended yet as PrEP or PEP in countries other than China, to answer my question, “Biktarvy” in my questions can be replaced as other PEP prescription that contains ingredients of FTC and TAF.

[Jim Allen]

Is this all theoretical or have you had an exposure?

If you are looking for PrEP you could take Descovy or Truvada, I see no reason for Biktarvy as PrEP.

[Jim Allen]

If I start taking Biktarvy as PEP, what should I do during the first 28 days if I have exposure to HIV again? My understanding is that I can stop taking  Biktarvy on (1) the last day of this 28 days’ period and (2) two days after the last HIV exposure, whichever day is later. Or does it have to be 28 days after the last exposure?

For example, if a high risk exposure occurs again on the 16th day of the 28-day PEP drug period but with no further high risk exposure occurs since then, then in fact, it is only necessary to take Biktarvy until the 28th day from the first high risk exposure. The reason is that Biktarvy should theoretically also be used as PrEP, and in this high risk exposure that occurs on the 16th day, since sufficient dose of Biktarvy has already been taken, it should be enough to prevent the risk of infection if the next 12 days of dosage is properly taken. However, if the high-risk exposure occurs on Day 28, then at least two more days of Biktarvy dose has to be taken to avoid being infected, according to the principle of on-demand PrEP administration. I don't know if I understand is correct. Looking forward to getting reply!

You should not be having any additional exposures or exposing people... ideally you should avoid the first exposure, but if it does happen and you take PEP don't have sex for 28 days and if you must then use condoms.

If you do ever have an exposure that warrants PEP you should start PEP as soon as possible post potential exposure and no later than 72 hours. If during PEP you do have additional sexual exposure then there is *generally no need to extend the PEP course unless it happens within the final few days of the course and that's being overly cautious.

Then test to confirm your HIV status six weeks after finishing PEP with a blood draw (lab) HIV antibody test. A non-reactive result at that time would rarely change, and retesting at three months is generally unnecessary.

*Come back to us or your healthcare provider if and when this happens with the details for more specific advice. 

Although Biktarvy hasn’t been approved to be used as PrEP or PEP, at least in China, I have been recommended here in China to take it as a prevention drug, both as PrEP and PEP, since Biktarvy is literally Descovy plus one more ingredient (BIK). Here I have some questions about how to take it and hope to get some answers.

You don't need Bictegravir.

You could take Truvada or Descovy daily as PrEP. With Truvada, you could also consider on-demand PrEP.  On-demand PrEP means taking a double dose of PrEP, 2-24 hours before sex, and then taking a single dose of PrEP for two days after sex.

Here is some additional information about on-demand PrEP.
https://i-base.info/guides/prep/on-demand
https://i-base.info/guides/prep/real-life-examples-for-on-demand-dosing

If you do start PrEP try to get an HIV & STI screening in addition to labs done every three months.

Here's what you need to know to reduce your HIV risks:
Use condoms for anal or vaginal intercourse correctly and consistently, with no exceptions. Consider talking to your healthcare provider about PrEP as an additional layer of protection against HIV

Keep in mind that some sexual practices described as safe in terms of acquiring HIV still pose a risk for other easier-acquired STIs. So please do get tested at least yearly for STIs, including but not limited to HIV, and more frequently if condomless intercourse occurs.

Also, note that it is possible to have an STI and show no signs or symptoms; testing is the only way to know.

Kind regards

Jim

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[Jim Allen]

You could also talk to your healthcare provider about PrEP and prehaps doxyPEP as well.   

doxyPEP is a single 200 milligram dose of doxycycline taken ideally within 24 hours post-sex to reduce risks from other STIs. This might not be approved usage in China but they do have doxycycline so you could consider asking for it. Also, consider getting vaccinated against HPV and Hepatitis a & b.