PrEP - always remember that there are

[corndog]

Condoms have a lower effective rate at 96%.

Even that number is optimistic. There is data that says they're 90-95% effective when used consistently, and real-world effectiveness maybe as low as 60-70%. All of the numbers for PrEP are significantly higher than this. Clearly, the best protection comes from using both together, but if you're going to choose just one or the other, the data suggests that PrEP is the safer choice.

 

https://www.ncbi.nlm.nih.gov/pubmed/9141163

http://www.aidsmap.com/Do-condoms-work/page/1746203/

[corndog]

One other weird thing with PrEp to watch out for is to not take Truvada (or really any medication) at the same time you are taking anything with psyllium husk, such as Pure for Men or Metamucil or many very common fiber supplements.

 

I don't think this idea is supported by facts. While there is a certain logic to it, it wasn't a factor during clinical trials and isn't listed as a problem in the Truvada prescribing materials. I would be very interested in links to any scientific basis for this recommendation.

[MikeBiDude]

One other weird thing with PrEp to watch out for is to not take Truvada (or really any medication) at the same time you are taking anything with psyllium husk, such as Pure for Men or Metamucil or many very common fiber supplements. This is because psyllium husk creates a gel in your digestive system that could actually prevent medications from being properly digested and absorbed into your system. Obviously, a lot of guys who bottom like to take things like Pure for Men to make their bowel movements thicker for easier clean up before sex. And you can still take the medication, just make sure it is a few hours after you take your Truvada so it has enough time to absorb in your system.

 

I found this video to be pretty explanatory: https://isprepforme.com/dont-take-prep-with-metamucil/

Hmmmm, I take psyllium husk capsules, usually an hour or two after my morning meds including Truvada. Maybe switch the psyllium to much later in the day....

[rvwnsd]

You made some very valid points. Unfortunately they were overshadowed with the smear of sarcasm....

 

Being a smart ass always kills the ability to bring forth understanding on any topic. I don’t know why people think it holds any value.

He is just being logical, not a smart ass....

Yep, that's right. I wasn't using sarcasm, being sarcastic, nor being a smart ass.

 

Hmmmm, I take psyllium husk capsules, usually an hour or two after my morning meds including Truvada. Maybe switch the psyllium to much later in the day....

I read something recently about avoiding taking calcium supplements at the same time you take certain supplements and meds, as the calcium can bind to the supplement/med and prevent full absorption. It recommended waiting two hours. I'll find the article and post it later.

[+ keroscenefire]

I don't think this idea is supported by facts. While there is a certain logic to it, it wasn't a factor during clinical trials and isn't listed as a problem in the Truvada prescribing materials. I would be very interested in links to any scientific basis for this recommendation.

 

It's commonly known that psyllium can potentially affect your absorption of medications generally. It's actually part of the packaging for Pure for Men and most other psyllium medications (https://www.pureformen.com/pages/frequently-asked-questions). While there hasn't been any studies directly with Truvada, and none of the PrEp failures seem to have a connection with psyllium, it could definitely lower the effectiveness. I actually told my PrEp nurse that I was taking psyllium and she cautioned me that it should not be taken at the same time as Truvada, but that I should be fine as long as I dose it a couple of hours after taking psyllium.

 

You can see it on here:

https://medlineplus.gov/druginfo/meds/a601104.html

 

https://www.medicalnewstoday.com/articles/318707.php

 

http://static.berkeleywellness.com/supplements/other-supplements/article/psyllium-and-nutrient-absorption

 

http://pennstatehershey.adam.com/content.aspx?productId=107&pid=33&gid=000976

[+ keroscenefire]

Hmmmm, I take psyllium husk capsules, usually an hour or two after my morning meds including Truvada. Maybe switch the psyllium to much later in the day....

You're probably fine taking it an hour or two after. My nurse who told me about this issue said I should be fine as long as I am not taking Truvada and psyllium at the same time.

[corndog]

It's commonly known that psyllium can potentially affect your absorption of medications generally.

 

I understand that psyllium is known to have effects on many medications, but Truvada is well studied, and interactions are well known. Psyllium is not listed by the manufacturer, or by other scientific sources, as an interaction with Truvada. Science matters.

 

https://www.drugs.com/drug-interactions/emtricitabine-tenofovir,truvada.html

[+ BenjaminNicholas]

Re: PURE before PrEP. It definitely seems to make sense, but I'd be interested to see more longterm research on it.

 

I use active charcoal capsules in my regular supplement routine and my ID doc told me to space that out from when I take my Truvada (4-6 hours).

[MassageAdam]

One other weird thing with PrEp to watch out for is to not take Truvada (or really any medication) at the same time you are taking anything with psyllium husk, such as Pure for Men or Metamucil or many very common fiber supplements. This is because psyllium husk creates a gel in your digestive system that could actually prevent medications from being properly digested and absorbed into your system. Obviously, a lot of guys who bottom like to take things like Pure for Men to make their bowel movements thicker for easier clean up before sex. And you can still take the medication, just make sure it is a few hours after you take your Truvada so it has enough time to absorb in your system.

 

I found this video to be pretty explanatory: https://isprepforme.com/dont-take-prep-with-metamucil/

 

I have gone to many many many drug rep dinners (over 20) on PREP and other HIV medications. I am a RN and have also worked in infectious disease... I'm sorry, but I haven't not heard of that once mentioned. With other medications and vitamins, yes, it's true. I would caution making a blanket statement like that from some guy on youtube. I have taken fiber every day for years and I eventually got on PREP after going to many presentations on the research behind it. It definitely would have rang some alarms in my head about he fiber and Prep interaction. My Roomate is a HIV doctor and knows I take prep and fiber and has never said a word to me about it either. There definitely isn't any harm in taking the two medications several hours apart though.

[+ keroscenefire]

I have gone to many many many drug rep dinners (over 20) on PREP and other HIV medications. I am a RN and have also worked in infectious disease... I'm sorry, but I haven't not heard of that once mentioned. With other medications and vitamins, yes, it's true. I would caution making a blanket statement like that from some guy on youtube. I have taken fiber every day for years and I eventually got on PREP after going to many presentations on the research behind it. It definitely would have rang some alarms in my head about he fiber and Prep interaction. My Roomate is a HIV doctor and knows I take prep and fiber and has never said a word to me about it either. There definitely isn't any harm in taking the two medications several hours apart though.

 

Good to know..thanks for your information. I didn't know about it either until my PrEp nurse practitioner told me about it after she asked about any new medications I was taking and told her that my PCP encouraged me to take psyllium for some mild digestive issues I had been having. Sounds like it's almost assuredly fine to take psyllium and Truvada at the same time, though I think I will still dose them a bit apart just in case.

[+ Eric Hassan]

It’s important that we understand that PrEP was intended to be used in CONJUNCTION with other methods of protection.

The gays are now doing what the straights did with “the pill”.... having bareback sex, thinking of only ONE issue rather than the others.

 

Everyone is now having this big barebacking party, thinking they are superhuman now they they claim to be free from any risk of HIV infection. However, no one is thinking about:

1.) the other numerous STD’s that PrEP doesn’t protect your from.

 

2.) how other medications one is taking will react to PrEP, and could possibly affect its overall efficacy.

 

3.) the possible side effects of long term use, and

 

4.) PrEP’s ability to work within ones system, that may already have other existing STI’s (for example, if a PrEP user currently had syphillis and gonhorrea, how is the medications reacting to the users compromised immune system to properly do its job to prevent HIV infection?

 

Also, as a side note, I find it alarming that so many people trust the government enough to regularly take a medication which they have sanctioned to prevent a disease that they claim they can’t cure.

 

This could be one huge unorthodoxed “clinical trial/experiment”....

 

1 - my experience has been that folks who use PrEP are more knowledgeable about other STIs and completely aware that PrEP does not protect against them - it's not that we are not thinking about it, it's that we accept a certain amount of risk, and we are connected with healthcare professionals with whom we can be open, and we follow the guidelines of seeing your doctor for follow up visits every 3 months

 

2 - when you are starting PrEP, your doctor asks you what other medications you take - in fact, being asked by your doctor what medications you take, to allow the doctor to prescribe responsibly and educate you on the medications you are taking, is standard practice and is no different when the conversation is about PrEP

 

3 - the medication that is PrEP has been around for well over a decade and has been well-studied - we know what the risks are, and people who use PrEP are, in my experience, well-versed in what side effects and long-term effects might be and part of the quarterly doctor's visits are to determine if there have been any adverse effects - like all medications, we could find out decades from now something that we don't yet know, but my experience is that most folks who take PrEP are willing to accept that risk

 

4 - there is no indication that another STI would diminish the body's ability to absorb PrEP, nor is there any reason to believe that PrEP would not work well because of another infection - the uptake of medication is not the same as your body's immune system taking on a bacterial infection - also, the medications in PrEP work on a cellular level preventing the VIRUS from replicating itself

 

i understand how it can seem careless and reckless for folks to take PrEP and bareback and you correctly state that the guidance on the use of PrEP includes other techniques for maintaining safety, but your other assertions are not based on reality - they are logical leaps that challenge the science and the lived experiences of those of us who choose to take PrEP - i implore you to educate yourself on how PrEP works in the body - there's a vast body of research out there, and the facts are easily google-able

[Monarchy79]

1 - my experience has been that folks who use PrEP are more knowledgeable about other STIs and completely aware that PrEP does not protect against them - it's not that we are not thinking about it, it's that we accept a certain amount of risk, and we are connected with healthcare professionals with whom we can be open, and we follow the guidelines of seeing your doctor for follow up visits every 3 months

 

2 - when you are starting PrEP, your doctor asks you what other medications you take - in fact, being asked by your doctor what medications you take, to allow the doctor to prescribe responsibly and educate you on the medications you are taking, is standard practice and is no different when the conversation is about PrEP

 

3 - the medication that is PrEP has been around for well over a decade and has been well-studied - we know what the risks are, and people who use PrEP are, in my experience, well-versed in what side effects and long-term effects might be and part of the quarterly doctor's visits are to determine if there have been any adverse effects - like all medications, we could find out decades from now something that we don't yet know, but my experience is that most folks who take PrEP are willing to accept that risk

 

4 - there is no indication that another STI would diminish the body's ability to absorb PrEP, nor is there any reason to believe that PrEP would not work well because of another infection - the uptake of medication is not the same as your body's immune system taking on a bacterial infection - also, the medications in PrEP work on a cellular level preventing the VIRUS from replicating itself

 

i understand how it can seem careless and reckless for folks to take PrEP and bareback and you correctly state that the guidance on the use of PrEP includes other techniques for maintaining safety, but your other assertions are not based on reality - they are logical leaps that challenge the science and the lived experiences of those of us who choose to take PrEP - i implore you to educate yourself on how PrEP works in the body - there's a vast body of research out there, and the facts are easily google-able

 

Thanks for the response and the detailed commentary, very insightful!!!

[+ Eric Hassan]

Thanks for the response and the detailed commentary, very insightful!!!

 

my pleasure, dude - thank you for reading it and responding. i'm grateful that you brought up your points, because i think those are things that folks worry about, and that would understandably lead to some concern about PrEP and barebacking, etc. ultimately, the point i always hope is a take away for everyone is that we are each responsible for our own safer sex practices, whatever they may be, and we all deserve respect for our choices.

[+ José Soplanucas]

Regular blood tests - at least for STIs - are part of the protocol, so this is suspicious why?

 

Why is it not possible public health agencies consider it a boon to public health and part of their effort to stop the spread of HIV? If you don't want to take it, don't.

 

Would you debate anti-vaxxers? My respect to you, but I would not waste my time.

 

[+ Eric Hassan]

Don’t we already know this to be true? Isn’t that why county health departments are giving it away if you submit to regular blood tests?

 

i believe that government health agencies are helping folks get PrEP as a way to stop the spread of HIV, particularly in vulnerable populations where there may be poverty and folks might be under- or un-insured. these are not experiments on the populace. rather, it is part of a multi-pronged approach to public health, with specific regard to HIV/AIDS. an example of this sort of planning and execution can be seen in new york state, where the governor has pledged to help decrease new infections, which will lead to a decreased prevalance of HIV and, eventually, to a cessation of new infections. it's a lofty goal, and might take longer than we will be alive, but it's not a willy-nilly experiment.

 

you can read more about this here: https://www.health.ny.gov/diseases/aids/ending_the_epidemic/

[+ quoththeraven]

Would you debate anti-vaxxers? My respect to you, but I would not waste my time.

 

No, I wouldn't debate anti-vaxxers because there's a much longer history, the one fraudulent study that supported them has been disavowed, and their position fundamentally misunderstands everything about vaccination and herd immunity and is a quest to benefit their kids at the expense of others. But Truvada as PrEP hasn't been in use for that long (although Truvada as treatment for AIDS has) and some qualms are due to ignorance.

 

That said, I have less patience with looking at it as though it's some kind of conspiracy against men who have sex with men, which is why I responded.

[SirBillybob]

Ibuprofen is contraindicated while taking Truvada. I switch to Acetaminophen or ASA for occasional headache use (unrelated to ARV meds) as needed during my on-demand PrEP cycles.

 

Psyllium husk is food and is water soluble. There are no food adjustment requirements for tenofovir/emtricitabine. I do not alter my psyllium consumption when taking PrEP because it does not affect the pharmacokinetics/bioavailability of the drug.

 

The most challenging requirement is increased water consumption for renal protection, because I have never felt particularly thirsty and I have an "urgent bladder". When taking PrEP I always need to be conscious of where I can pee if out doing some activity.

[Rudynate]

This is an interesting case in Australia as the person who seroconverted was not taking a daily dose of PrEp but was rather taking before and after sex, known as "on-demand" PrEp. While studies have shown "on-demand" to be as effective as taking Truvada daily, I think it's clear the dosing is a bit trickier as the timing has to be pretty precise. It may be kind of akin to taking birth control everyday and taking the morning after pill...they both can be effective, but in the latter the dosing timing definitely can have influence on the effectiveness of the medication.

 

https://www.poz.com/article/case-ondemand-prep-failure-reported-australia

 

The reality is that we don't really know if this is a case of PrEp failing or the dosage failing. I take Truvada every day when I get up in the morning and to me that is easier to remember and be consistent that trying to dose it before and after sex.

 

 

No, the studies have not shown that. The demand dosing protocol is known to be less effective than daily dosing. Not by much, but by a significant amount.

[SirBillybob]

Some of the confounders comparing daily versus demand related to the reduced distinction between the sexual patterns of the two groups. More frequent sex among some in the demand group amounted to up to an average of 25 doses per month. This is analogous to taking continuous PrEP substandardly in the context of a frequency of anal intercourse that would ordinarily call for the daily regimen.

 

Therefore, a lot has to do with taking the chosen course appropriately ... not news.

 

In contrast, in the substudy of demand PrEP compared to demand placebo, each group's average pill dose frequency was about 15 per month ... equivalent to about 3-4 sex cycles based on, give-or-take, two simultaneous pills before followed by one pill on each of two subsequent days.

[SirBillybob]

Help me out, please. A poster wrote in these related PrEP threads quoting an 86% something-or-other. I was skimming, then could not find the post during a more detailed read.

 

Where is that post? Was it removed?

 

Please tell me the thread name and the date of that specific contribution.

[MassageAdam]

Ibuprofen is contraindicated while taking Truvada. I switch to Acetaminophen or ASA for occasional headache use (unrelated to ARV meds) as needed during my on-demand PrEP cycles.

 

Psyllium husk is food and is water soluble. There are no food adjustment requirements for tenofovir/emtricitabine. I do not alter my psyllium consumption when taking PrEP because it does not affect the pharmacokinetics/bioavailability of the drug.

 

The most challenging requirement is increased water consumption for renal protection, because I have never felt particularly thirsty and I have an "urgent bladder". When taking PrEP I always need to be conscious of where I can pee if out doing some activity.

Where did you get that information about Ibuprofen and Truvada? I can't find any legitimate sources that say that. I am a RN and I have been to many presentations about Truvada and that has NEVER been mentioned.

[SirBillybob]

Sorry, I do not know why you cannot find this info.

 

NSAIDS add to the extreme workout that Truvada confers [sorry, should be "imposes", not confers] on our kidneys. My follow-up PrEP team at a top-drawer clinical research centre always says: remember, drink lots of water and do not take any Advil.

 

Try googling 'truvada nsaids' and follow the trail.

Edited May 20, 2019 by SirBIllybob

[+ keroscenefire]

Help me out, please. A poster wrote in these related PrEP threads quoting an 86% something-or-other. I was skimming, then could not find the post during a more detailed read.

 

Where is that post? Was it removed?

 

Please tell me the thread name and the date of that specific contribution.

The 86 percent effectivenes in a study was found in this article: https://www.poz.com/article/IPERGAY-CROI-26854-6956

[SirBillybob]

Oh, right. Thanks.

 

On demand PrEP was 86% more effective for drug (.9% infection over average 9 months, with acknowledgement among the 2 subjects they had stopped the pills) compared to placebo (6% infection rate; n = 14 infected). Essentially, PrEP taken properly was very effective.

[MikeBiDude]

Another current thread here:

https://www.companyofmen.org/threads/truvada.148882/post-1722841