Taking Truvada daily

[skyhorse]

I am in US.  I went to an infectious disease doctor to get evaluated to be put on Truvada regimen. I was put on a daily regimen and my question here is do I indeed need to be on the daily regimen given my sexual activity.

My history is that I hook up occasionally using Grindr, or use other venues of acquiring sexual partners.  Before Truvada was approved, I had the following rule about anal sex when I first started - "No anal sex", as my impression was that HIV is most transmitted through anal sex, especially receptive.  Later I changed my rule to "avoid anal sex, but if things are going towards anal, to always use condoms".

Fast-forward to now, I am considering starting on Truvada, and I've heard various conflicting regiment options

• The popular 2-1-1 regimen for anal sex
• Take Truvada 1 week before extended sexual activity (i.e. a weekend of sex) then one week afterwards, then stop
• Take Truvada daily (this one was recommended to me by my infectious disease specialist doctor)
• Not taking Truvada at all & use condoms

Since it is still advisable to use condoms when taking Truvada, I don't see my behavior changing in that regard.  i.e. I should not be having sex raw despite taking Truvada.

My question is this - given that

• I am anal sex-averse (it is not my preferred activity)
• I rarely engage in receptive anal sex, and when I do, I use a condom
• I typically do not engage in penetrative anal sex

should I still be on the daily Truvada regimen?
That said, there is one partner whom I trust with whom I have unprotected anal sex.  I've known that partner for years and had many occasions of sex with him without Truvada and without condoms.  Before that on very rare occasions I had unprotected sex with known partner. 

The above has been my behavior for a while without taking Truvada, and I am HIV negative. 
If having receptive anal sex been my preferred and frequent activity I would have no questions about being on Truvada.
However, given my behavior with respect to anal sex, should I still indeed be on the daily Truvada regimen?

[Jim Allen]

Hiya,

I'll give some highlights on this topic, and hopefully, that will help.

Understand you are in the US, and PrEP 2-1-1 isn't supported by the FDA or CDC last time I checked. Although WHO does support this and some US clinics offer this option.

I'll skip talking about injectable PrEP (CAB) or the Vaginal Ring (Dapivirine) and focus on PrEP pills. Generally, there are two ways to take PrEP in pill form that are supported by studies:

- Daily PrEP
- PrEP 2-1-1 (PrEP On-Demand)

PrEP 2-1-1 is prehaps more suitable if you don’t often have sex and can be less expensive because you need fewer pills.

However, it would not suit everyone as not everyone can plan ahead to take the first two pills between 2 and 24 hours before having sex and prehaps not applicable to you, but it can not be used by women for vaginal sex or by trans men for frontal sex.

Daily PrEP has the additional benefit of drug choice for some people between Descovy (TAF/FTC) or Truvada (TDF/FTC). 

Descovy (TAF/FTC) is a newer drug that can be kinder on the kidneys and bone density than Truvada (TDF/FTC). Although, Descovy has been associated with weight gain and elevated cholesterol. There are generic versions of Truvada (TDF/FTC) that can be cheaper, but there is no generic version of Descovy (TAF/FTC) and Descovy PrEP has only been studied in men who have sex with men + trans women. 

That said, there is one partner whom I trust with whom I have unprotected anal sex.  I've known that partner for years and had many occasions of sex with him without Truvada and without condoms.  Before that on very rare occasions I had unprotected sex with known partner.

Obvouise prehaps, but ill still mention it, HIV doesn't care about trust or how well you know someone and trust does not prevent HIV. I get to hear plenty of sad stories that start with "I trusted them".

I went to an infectious disease doctor to get evaluated to be put on Truvada regimen. I was put on a daily regimen and my question here is do I indeed need to be on the daily regimen given my sexual activity.

should I still be on the daily Truvada regimen?

The question I can't answer for you. Ultimately you need to decide what version of PrEP is best for you and your circumstances.

I would recommend discussing the option of 2-1-1 PrEP again with your healthcare provider.

Best, Jim.

https://www.cdc.gov/hiv/basics/prep/on-demand-prep.html
https://www.poz.com/drug_charts/hiv-prep-drug-chart

https://www.aidsmap.com/about-hiv/truvada-or-descovy-which-should-i-take-prep
https://www.aidsmap.com/about-hiv/pre-exposure-prophylaxis-prep