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PREP and PEP questions

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Ruminator:
Hello,

8 days ago, I put myself in a potentially risky situation. I was in a group sex situation and intoxicated (bad combo) and there were some moments where things were unclear and there may have been a brief period on unprotected anal. Some background, I was on PREP in 2019 and stopped after getting into a monogamous relationship.  I anticipated the group sex situation above and started on demand PREP beforehand by taking 2 Truvada pills within the prior 24 hours. I have been taking Truvada daily since then as well as getting started on PEP 36 hours after the event by adding Tivicay. 
My concerns are that the PREP pills were from 2019 and had an expiration date of August 2020.  I've read things where in general expiration dates are conservative and expired pills can last for years after that date but those tests didn't involve Truvada.  The other concern was that I didn't take the 1st 2 pills for PREP at the same time. I took them about 8 hours apart for some reason.  I guess I didn't initially interpret the PREP schedule as 2 pills simultaneously but as 2 pills at any time within the 24 hour period.  Finally, I have read articles about PEP that say not to have unsafe sex while on PEP because it increases the chance of PEP failure.  However, part of PEP is Truvada so shouldn't this be protective.  If Truvada makes PREP safe, shouldn't it make PEP safe?  The articles where I read this may be older and maybe before PREP was a thing so this information might be outdated now.  I haven't had an additional unsafe encounters - just wondering.

So in summary, questions are
1)  Is it reasonable to assume Truvada will still work 10 months after the expire date?
2)  With on-demand PREP and the 2-1-1 schedule, do you think think the timing of the first 2 pills is critical (instead of 2 at the same time, they are spaced by 8 hours or so)?
3)  When on PEP, are you protected from unsafe sex like you would be on PREP?  It seems intuitive that you would be but I have read things to the contrary.

Ruminator:
I should add that when I went on PEP, I got new Truvada pills as well.  So I only was using the old pills until 36 hours after the incident (basically the PREP time).

Jim Allen:
1) Yeah
2) Pharmacokinetic - I sure know about that, but the idea of correct dosage is to reach a certain level in the blood and tissue to help reduce the odds of infection, and outside of the single dosage and the tested on-demand routine, I would not know and dare not comment.
3)Yes. However, if you do have HIV you could still pass it on asides from picking up whatever other infections.


--- Quote ---there may have been a brief period on unprotected anal
--- End quote ---

Understand and that you have started PEP within 72 hours. PEP is highly effective so relax, keep taking it as prescribed and test 6 weeks post finishing the PEP course with a blood-drawn HIV antibodies test to know your HIV status. A negative (non-reactive) result at that time would rarely ever change. If you wish, you can repeat this test at 3 months post finishing the PEP for a definite result, although it's generally not needed.


--- Quote ---getting into a monogamous relationship
--- End quote ---

So not many details to go on but ill mentioned the same thing for anyone in a relationship if you have engaged in condomless intercourse with your partner you are obviously at risk of acquiring HIV. Often within relationships, condomless sex is based on trust or past test results, however, this does not prevent HIV and any condomless intercourse is accepting the greater risk of acquiring HIV.

Here's what you need to know to avoid HIV infection:
Use condoms for anal or vaginal intercourse, correctly and consistently, every time, no exceptions. Consider talking to your healthcare provider about PrEP in the future as an additional layer of HIV protection

Keep in mind that some sexual practices described as ‘safe’ in terms of HIV transmission might still pose a risk for transmission of other STI's, so please do get tested regularly and at least yearly for all STI's including but not limited to HIV and test more frequently if unprotected intercourse occurs

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

Kind regards

Jim

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Ruminator:
Thanks for your response.  I agree about monogamy potentially giving a false sense of security.  However, taking Truvada long term, from what I understand, is also not without its risks.  It is a trade-off I guess.

Jim Allen:

--- Quote ---Thanks for your response.

--- End quote ---

np.


--- Quote --- I agree about monogamy potentially giving a false sense of security.  However, taking Truvada long term, from what I understand, is also not without its risks.
--- End quote ---

The trade-off, let's see taking far more meds for life, living with an illness that means most people treat you like shit, shortens your lifespan, costs a fortune and can fuck up your health despite treatment or the happy bullshit stories you may hear vs taking an extremely light version of meds now to prevent these issues and/or using condoms.

From my side of the fence, I think you have an opportunity to choose the greener side.

Anyhow, end of the day it's your own choice, just be aware of the real-world risks. I've heard far too many sob stories here already that start with "I trusted my partner, husband, wife etc" "they tested in the past etc"  Don't become the next classic story.

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