prep not recomended by dr

[2tcells]

had my dr appt today and brought my gf to get a prep prescription since she has birth control and we don't use condoms anymore, the dr has been wanting her to get this for awhile but now he says its not recommended or necessary because im ud and take my meds when im suppose to. I was surprised and hadn't heard of this until today. he said its the new recommendation for the last 4 months. anybody else know about this? thoughts?

[AusShep]

My husband had a doctor a couple of years ago say it wasn't really necessary, but a new one who specializes in LGBT does recommend it, probably due more to potential slip ups he probably sees happen more than my status. 

[Lightfighter]

My ID doc told my wife and I the same around this time last year

[Almost2late]

My doctor still hands out condoms like they're lollipops.. 

[harleymc]

Your viral load has been below 200 for a few years now.

There's just no evidence that HIV can be transmitted as long as this situation continues.

[CaveyUK]

My doctor said the same thing.

Ie. I'm UD, so PrEP wouldn't be prescribed, even if it were available on our health service (which it isn't, yet).

There is logic to it. If you are UD and stable then the risk of transmission is negligible (close to zero, if not actually zero), so why introduce expensive drugs which MAY have some side effect long term? In the highly unlikely event she did contract the virus - which would be big news in itself of course - then early detection and starting those drugs would retain her life expectancy anyway.

PrEP is really designed for those who have unprotected sex with partners of unknown status, ie. the population where HIV infection is at the highest level. Given all the latest research on transmissibility when undetectable, I suspect your doctors viewpoint won't be uncommon.

[2tcells]

my dr pretty much said the same caveyuk said. he said the chances she gets it from me are as close to zero without being able to say zero %, because there have not been any new studies on it. sounds good to me! I don't like condoms lol. are there any studies keeping track of hiv poz and hiv neg couples who don't use condoms?

[Jim Allen]

are there any studies keeping track of hiv poz and hiv neg couples who don't use condoms?

In what sense?
Plenty of studies past and they just published the newest results a few weeks ago, http://www.aidsmap.com/page/3159603/

 

[AusShep]

In what sense?
Plenty of studies past and they just published the newest results a few weeks ago, http://www.aidsmap.com/page/3159603/

During the Opposites Attract study, three men became infected with HIV, but genetic analysis showed that these infections came from a partner outside the main relationship who was not virally suppressed.

This is similar to the PARTNERS study, and probably why some SF doctors are recommending PrEP even to "monogamous" couples along with the county's zero new transmissions goal. 

[Jim Allen]

  Not sure we on the same page, I was just answeing the question if they track it. They sure do in studies as exsample.

Agreed that PrEP is not a bad thing as we push towards 90-90 Goals, and could help many nations get closer to that goal sooner it's also up to the negative partner to decide for themselves how to protect themselves in life, it's their health so there is no right or wrong answer. Each must way off the risks and trust they have with their partner or partners in some cases, and choose a level of risk advoidance they are comfortable with and that works for them and their situation.

Devil's advocate on reporting topic now if someone goes off treatment and at some stage in the real world as exsample transmits the virus there is very little data, other that the head line news cases, so sure it does happen and know adherence is shaky for some. Such a case outside of a focused study would just count in general infection numbers, so not against any ud statistics as they would no longer be ud also sources are hard to trace at times, this has always been the case.  I doubt (hope not) that anyone of the HIV positive partners in studies would ever be that foolish or take such a risk.

Be adherent, reduce risks to your health and others arround you, let others decide for themselves.

Jim

[AusShep]

I think we're on the same page. 

Transmission from an UD is near zero, it's never been confirmed.   But slip ups happen, not sure how well this translates from gay to straight couples like 2tcells.  But PrEP parameters include neg with a positive partner, it's up to the negative partner to assess their risk based on their own actions as well as their partner staying adherent to their meds. 

[CaveyUK]

I think we're on the same page. 

Transmission from an UD is near zero, it's never been confirmed.   But slip ups happen, not sure how well this translates from gay to straight couples like 2tcells.  But PrEP parameters include neg with a positive partner, it's up to the negative partner to assess their risk based on their own actions as well as their partner staying adherent to their meds.

Policy on this may be regional as well

You are correct though - in a setting where the neg partner is likely to have unprotected sex outside the relationship, or has a partner who is haphazard in their taking of meds, then PrEP would absolutely be something to look into and I'm sure if those facts are presented to a doctor - even where it would not normally be prescribed - there would be be a good chance of success.

[2tcells]

thanks for the link. that is what I was asking about, I didn't know there was a newer study.

[CallMeSid]

I believe that the most recent cliinical practice guidelines for PreP are these issued by the CDC in 2014:

https://www.cdc.gov/hiv/pdf/guidelines/PrEPguidelines2014.pdf

As a heterosexually active woman in an ongoing sexual relationship with an HIV-positive partner, your girlfriend meets the recommended indications for PreP.  (See Box B2 on Page 29.)

When your doctor said that "it's not recommended", did you follow-up to ask "not recommended by whom?".  Your girlfriend might get her preventative health care needs met best by going to her own physician instead of having her boyfriend talk to his doctor on her behalf.  Just sayin'...

[Bartlett]

I noted in the pregnancy thread the same thing. My doc (as well as my wife's) are fine not only with no condoms but not putting her on anything. Hard to wrap my mind around considering how condom only was pushed so hard after DX.