Truvada

[TruthBTold]

Not sure if anyone else in the world is still taking Truvada or not. I may just be one of the old timers that is. At any rate, I went in for the blood draw that you are supposed to do in conjunction with the prescription writing and my doctor let me in on a couple of things that I really did not know. It may have been because I did not ask. For example, it had always been impressed on me that I was ABSOLUTELY supposed to make sure that I took my little blue pill every day and never miss one. However, my doctor told me that really they have found that unless you are a Grindr sort of guy who is lucky enough to be able to have sex spontaneously (if that is your dream) you could take the pill a couple of days before you plan on having sex and that should cover you. (Caveat: I did not ask him if that meant pill plus condom or if the couple of days of pill is sufficient). Also he told me that the trademark for Truvada is running out either this or next year so there will be a generic. However, he did mention that as these things are done the company is coming out with a pill that is going to be safer for the body system to take (e.g. kidneys) and that obviously will not be generic. So the company will still make the zillion dollars of profit off a copyrighted drug. I apologize if this is info that everyone has known forever but I thought I would post it just in case the info has not made its way here. Have a wonderful weekend.

[MikeBiDude]

Not sure if anyone else in the world is still taking Truvada or not.

One here

[Guest LeonTrotsky]

Not sure if anyone else in the world is still taking Truvada or not. I may just be one of the old timers that is. At any rate, I went in for the blood draw that you are supposed to do in conjunction with the prescription writing and my doctor let me in on a couple of things that I really did not know. It may have been because I did not ask. For example, it had always been impressed on me that I was ABSOLUTELY supposed to make sure that I took my little blue pill every day and never miss one. However, my doctor told me that really they have found that unless you are a Grindr sort of guy who is lucky enough to be able to have sex spontaneously (if that is your dream) you could take the pill a couple of days before you plan on having sex and that should cover you. (Caveat: I did not ask him if that meant pill plus condom or if the couple of days of pill is sufficient). Also he told me that the trademark for Truvada is running out either this or next year so there will be a generic. However, he did mention that as these things are done the company is coming out with a pill that is going to be safer for the body system to take (e.g. kidneys) and that obviously will not be generic. So the company will still make the zillion dollars of profit off a copyrighted drug. I apologize if this is info that everyone has known forever but I thought I would post it just in case the info has not made its way here. Have a wonderful weekend.

 

Check out "Descovy"

[MikeBiDude]

Check out "Descovy"

Seems to be used only if you’re already HIV positive? Not as PrEP

Descovy is not yet approved for use as pre-exposure prophylaxis (PrEP)

 

https://www.poz.com/drug/descovy

[+ oldNbusted]

Seems to be used only if you’re already HIV positive? Not as PrEP

Descovy is not yet approved for use as pre-exposure prophylaxis (PrEP)

 

https://www.poz.com/drug/descovy

 

 

To be fair, @TruthBTold wasn't specific in the OP.

 

Good news is they have applied for approval, here is a story from last month:

 

Gilead Requests Approval of Descovy for PrEP

[+ keroscenefire]

Yes, there is a lot of controversy with Truvada and its maker Gilead. The US government actually paid for most of the research that found out that Truvada could be used to prevent HIV. Yet Gilead charges kind of insane amount for the drug..more than $1500 per month even though the wholesale price is only around $5-6 per month. That's actually what many pay in other countries. There are some generic versions coming but Gilead is trying to keep it higher price by introducing a slightly altered medication and recommending that one is prescribed instead of Truvada. A lot of controversy there for sure.

 

I do take it too.

[Rangar]

if you have Netflix check out Dirty Money-"Drug Short"

[MscleLovr]

Did you see the interesting exchange between Alexandria Ocasio-Cortez and the Gilead CEO on why the drug costs $1780 in the US but only $8 in Australia?

 

[Monarchy79]

Not sure if anyone else in the world is still taking Truvada or not. I may just be one of the old timers that is. At any rate, I went in for the blood draw that you are supposed to do in conjunction with the prescription writing and my doctor let me in on a couple of things that I really did not know. It may have been because I did not ask. For example, it had always been impressed on me that I was ABSOLUTELY supposed to make sure that I took my little blue pill every day and never miss one. However, my doctor told me that really they have found that unless you are a Grindr sort of guy who is lucky enough to be able to have sex spontaneously (if that is your dream) you could take the pill a couple of days before you plan on having sex and that should cover you. (Caveat: I did not ask him if that meant pill plus condom or if the couple of days of pill is sufficient). Also he told me that the trademark for Truvada is running out either this or next year so there will be a generic. However, he did mention that as these things are done the company is coming out with a pill that is going to be safer for the body system to take (e.g. kidneys) and that obviously will not be generic. So the company will still make the zillion dollars of profit off a copyrighted drug. I apologize if this is info that everyone has known forever but I thought I would post it just in case the info has not made its way here. Have a wonderful weekend.

 

Very useful information!!!

I’m no doctor, but I’d recommend continuing daily doses of that medication, unless you are a 100% condom user.

[+ Axiom2001]

Yes, there is a lot of controversy with Truvada and its maker Gilead. The US government actually paid for most of the research that found out that Truvada could be used to prevent HIV. Yet Gilead charges kind of insane amount for the drug..more than $1500 per month even though the wholesale price is only around $5-6 per month. That's actually what many pay in other countries. There are some generic versions coming but Gilead is trying to keep it higher price by introducing a slightly altered medication and recommending that one is prescribed instead of Truvada. A lot of controversy there for sure.

 

I do take it too.

 

"...more than $1500 per month" is horrendously exploitative and very damn expensive. I found this out last month when I got my monthly supply. I am getting my meds prescribed through a superb agency in San Francisco although I live in another city and county in California. ...have insurance but did not want to go through lots of changes and am not using.

 

My meds are paid for via Gilead, I think. The assistant at COSCO brought me my big blue pills and told me they would be $1800; I looked and thought, "what happened." He did a double or third check and relayed that he'd forgotten the certificate or coupon. Afterwards, I left w/o having to fork up a dollar.

 

We who use this firm in "The City" are truly, truly, truly fortunate. I know I don't have that type of money to pay for any medication, especially for a meager monthly supply.

Edited May 21, 2019 by Axiom2001

[+ sam.fitzpatrick]

I feel fortunate that my health insurance through my employer covers Truvada. I only pay $10 co-pay.

 

What I do find intriguing is that the insurance will not cover a 90-day supply and I must refill every 30 days. My physician and my pharmacy indicate that they have several other patients whose insurance does allow a 90-day refill.

[TruthBTold]

I feel fortunate that my health insurance through my employer covers Truvada. I only pay $10 co-pay.

What I do find intriguing is that the insurance will not cover a 90-day supply and I must refill every 30 days. My physician and my pharmacy indicate that they have several other patients whose insurance does allow a 90-day refill.

 

I know. I am with you on that. It makes no sense. As nice as they are, they ask the same the same insipid questions each time you call. And I too can only get a 30 day supply. Now that my doctor has filled me in on the information about the efficacy of the drug as regards sexual activity I am only going to take it when I know that I am going to have sex. Perhaps for some it will be a real hardship but for me I can work it out. As I get it for free through my insurance/Gilead program I would love to find a way to get it to someone who could use it - perhaps for the medication for AIDS treatment (as opposed to PrEP). I know it would be illegal but so should forcing people to pay huge amounts of money to get the drug in the first place. The one thing I have to find out is if you decide to only take the drug a few days before sex do you wind down or do you just stop entirely? Many of my other medications require me to wind down if I want to go them. I am not sure if Truvada is one of them.

[MikeBiDude]

I am only going to take it when I know that I am going to have sex.

I, for one, think you should get a second doctor’s opinion on this.

[Guest]

Well, Truvada is supposed to be taken every day. Obviously, if you don't have sex for 6 months, you probably don't need to take it, but when you can stop after sex hasn't been determined. If you're having sex very infrequently, I'm not sure if the risk of taking Truvada (i.e. permanent kidney damage) is worth the potential benefit. If I were a bottom and having more than 4 sexual partners per year, I'd probably take it daily.

[SirBillybob]

There is a lot of easily accessible research on comparing both the effectiveness, and MSM consumer reasons/preferences, for daily versus OnDemand/intermittent/pericoital PrEP.

 

The guidelines for on-demand are a little more specific than the OP represented, based on his summary of his MD's description. This option is far more commonly utilized in Europe and Canada compared to USA.

 

I take the on-demand course, though I have the same very low cost burden for either method.

 

I think somebody mentioned donating their unused/stockpiled Truvada to a poz person that might be in need. NEVER make this call. Truvada is not used as a solo agent for HIV treatment. That is why routine testing is recommended for PrEP users. If seroconversion occurs, a different standard of medication is used for viral suppression and to prevent the complexities of drug resistance.

[+ VictorPowers]

if you have Netflix check out Dirty Money-"Drug Short"

That series sucked me in! I just recommended that one to @ArVaGuy

[Rudynate]

Not sure if anyone else in the world is still taking Truvada or not. I may just be one of the old timers that is. At any rate, I went in for the blood draw that you are supposed to do in conjunction with the prescription writing and my doctor let me in on a couple of things that I really did not know. It may have been because I did not ask. For example, it had always been impressed on me that I was ABSOLUTELY supposed to make sure that I took my little blue pill every day and never miss one. However, my doctor told me that really they have found that unless you are a Grindr sort of guy who is lucky enough to be able to have sex spontaneously (if that is your dream) you could take the pill a couple of days before you plan on having sex and that should cover you. (Caveat: I did not ask him if that meant pill plus condom or if the couple of days of pill is sufficient). Also he told me that the trademark for Truvada is running out either this or next year so there will be a generic. However, he did mention that as these things are done the company is coming out with a pill that is going to be safer for the body system to take (e.g. kidneys) and that obviously will not be generic. So the company will still make the zillion dollars of profit off a copyrighted drug. I apologize if this is info that everyone has known forever but I thought I would post it just in case the info has not made its way here. Have a wonderful weekend.

I get a generic from India-$55.00/month.

[+ VictorPowers]

I feel fortunate that my health insurance through my employer covers Truvada. I only pay $10 co-pay.

 

What I do find intriguing is that the insurance will not cover a 90-day supply and I must refill every 30 days. My physician and my pharmacy indicate that they have several other patients whose insurance does allow a 90-day refill.

I switched insurances and went from 90 to 30. My Dr. advised me that you can call them and make a request to allow 90. I haven’t done this yet, but it may be worth looking into.

[Rudynate]

Makes sense that they don't want to cover 90 days. If you fail on the medication or stop for any other reason, it reduces their loss.

[josh282282]

For example, it had always been impressed on me that I was ABSOLUTELY supposed to make sure that I took my little blue pill every day and never miss one. However, my doctor told me that really they have found that unless you are a Grindr sort of guy who is lucky enough to be able to have sex spontaneously (if that is your dream) you could take the pill a couple of days before you plan on having sex and that should cover you.

 

 

Um, NO, NO, NO its 7 (seven) days taking Truvada EVERY DAY before it can work in preventing HIV transmission for a bottom, not sure about the days needed for a top as the studies are not clear. AND, it takes 20 days to achieve maximal concentration in the blood. Starting "a couple of days" before sex WILL NOT WORK. The studies do NOT show that!!

 

FYI: I'm a physician who works as an HIV Specialist.

 

You dont believe me? Here is a cut & paste from the CDC.

"When taken every day, PrEP is safe and highly effective in preventing HIV infection. PrEP reaches maximum protection from HIV for receptive anal sex at about 7 days of daily use. For receptive vaginal sexand injection drug use, PrEP reaches maximum protection at about 20 days of daily use. No data are yet available about how long it takes to reach maximum protection for insertive anal or insertive vaginal sex." (clarification from Josh: receptive= bottom; insertive=top)

 

1) PLEASE do NOT give medical advice here on Daddys. You are giving wrong & dangerous advice, sir. I suspect you misunderstood your doctor. What if someone took your (wrong) advice and becomes HIV infected? Should you feel bad? (yes)

2) Go back & review this with your physician. You need more guidance (or he does).

[+ easygoingpal]

Um, NO, NO, NO its 7 (seven) days taking Truvada EVERY DAY before it can work in preventing HIV transmission for a bottom, not sure about the days needed for a top as the studies are not clear. AND, it takes 20 days to achieve maximal concentration in the blood. Starting "a couple of days" before sex WILL NOT WORK. The studies do NOT show that!!

 

FYI: I'm a physician who works as an HIV Specialist.

 

You dont believe me? Here is a cut & paste from the CDC.

"When taken every day, PrEP is safe and highly effective in preventing HIV infection. PrEP reaches maximum protection from HIV for receptive anal sex at about 7 days of daily use. For receptive vaginal sexand injection drug use, PrEP reaches maximum protection at about 20 days of daily use. No data are yet available about how long it takes to reach maximum protection for insertive anal or insertive vaginal sex." (clarification from Josh: receptive= bottom; insertive=top)

 

1) PLEASE do NOT give medical advice here on Daddys. You are giving wrong & dangerous advice, sir. I suspect you misunderstood your doctor. What if someone took your (wrong) advice and becomes HIV infected? Should you feel bad? (yes)

2) Go back & review this with your physician. You need more guidance (or he does).

 

Thank you for posting this information... It's best to be on the safe side.

[MikeBiDude]

FYI: I'm a physician who works as an HIV Specialist.

Voice of reason on this thread.! ??

[SirBillybob]

The International Antiviral Society -USA panel is accepting of the on-demand 2 pill 24 hours prior to RAI uptake standard based on the Ipergay study. I believe the reference is in JAMA and easily accessed.

 

For intermittent semi-spontaneous anal intercourse, 7-day blood plasma loading is unrealistic for many fellows at a practical level. Postponing a rare fuck opp don't work that way. We tend to want it and to want it stat. And as mentioned, PrEP is not intended to replace condom use.

 

I do consult my ID specialist and switched a year ago from the 7-day single dose to 24-hour pre-coital double dose, even though I always know 7 days or more ahead of time when sex is going to occur, and even though cost is a non-issue for me.

 

Granted, I neither expect readers to follow my decision nor the advice of a physician not in their care cascade.

 

If IAS-USA and CDC want to duke it out on behalf of American MSM, fine with me. I am neither American nor USA-centric. CDC guidelines, while reputable and respect-worthy, are not global guidelines.

[josh282282]

The International Antiviral Society -USA panel is accepting of the on-demand 2 pill 24 hours prior to RAI uptake standard based on the Ipergay study. I believe the reference is in JAMA and easily accessed.

 

What you wrote above is NOT what this debate between the OP & myself was about!!

You are behaving JUST like him by NOT paying attention to detail, and needing to put your 2-cents in, & then trying to sound authoritative and potentially helping others HARM themselves- meaning, getting HIV INFECTED. I know you dont want to harm others, but you just might with your recklessness and (inappropriate) need to put your 2-cents in.

 

Hear me out:

 

The OP discussed starting Truvada where he could just "take the pill a couple of days" before sex. He did NOT discuss a regimented & studied Truvada protocol that you mention (but did not elaborate on). "A couple of days" is reckless & without scientific merit. Someone can get HIV doing it this way. And the OP listing it this way can (unfortunately) lead other readers to (inaccurately) think, "Hey, I can do this way, too!" and then unfortunately get HIV!!!

 

By inserting your poorly described opinion, you can potentially erode the point I am trying to make which is giving medical advice is DANGEROUS, even by a trained professional such as myself. One (including myself) must be careful in giving statements/advise about important medical topics (such as preventing HIV TRANSMISSION). (Unfortunately) Thousands of men are infected every year and your argument you (needlessly) discussed above only risks adding to that tragic reality.

 

 

FYI: the experts (such as myself) are divided on the appropriateness of On-Demand PrEP which you carelessly and inaccurately mentioned (your dosing schedule regimen was poorly/incorrectly described) in your post. The reason why: it doesnt always work (for reasons are outside the scope of this post- want to discuss more? Start a NEW topic so as to not confuse & potentially harm people).

 

There are many intelligent & well-read men who read this website and would never dream of getting medical advice from here, including getting medical advice from me, Dr Anonymous. But there are the occasional idiots who DO read the wrong stuff & do the wrong thing and get wrong outcome (like getting HIV). Please do not contribute to this problem. You are likely intelligent and well-meaning, but you got it wrong here. My fear is your ego will prevent sufficient self evaluation to see if I have any good point to be made.

 

The first precept of Good Medicine is First Do No Harm. You failed on this.

 

Do you understand my point?

[SirBillybob]

I understand what you are trying to say, josh282282.

 

My impression reading the OP was that has his physician was describing the now widely accepted on-demand PrEP regimen. That was my assumption because the OP had described enough features of that regimen that lined up with the instructions accompaning the Tenofovir-Emtricitabine bottles dispensed to me and thousands of others in several parts of the world.

 

The OP's description fell short of the details of this IPERGAY research-supported regimen. However, he did not suggest that he was going to take PrEP willy-nilly without following the instructions for the version of PrEP he would ultimately select.

 

I will risk a paradoxical bind at this juncture. You suggest that I did not elaborate on my on-demand PrEP preference, yet if I now describe that regimen you may be inclined to assert that I am trying to endorse it without the solid research underpinnings you seem to dismiss or be unaware of.

 

But here goes: 2 pills 2 to 24 hours prior to first sexual activity, followed by 1 pill taken daily until 48 hours following the last sexual activity. My most recent course equalled 14 doses for 10 days of expected activity. Such cycles of usually similar length occur, in my case, a few times within the year.

 

You rightly weighed in out of concern that the OP and others would not take PrEP properly. You described a consumption standard, 7-days preparatory PrEP, that remains consistent with the elective option of continuous PrEP uptake .... 7 days of consumption prior to having or resuming intercourse at a level of frequency supporting continuous (as opposed to on-demand) is not an imposition because it is likely going to be a one-time basis, or a less frequent but longer wait-period requirement in the context of sustained cycles of high-risk sex.

 

On the subject of motive, you are imputing to me irresponsible or reckless intent. Unfortunately, this is just an example of WYSIATI bias ... what you see is all there is. Embellishing your point by needlessly conflating my rendering of the description of my physician's instructions with the proffering of amateurish clinical advice.

 

I had already clarified that I was not giving a personal opinion but that I was following the guidelines that emerged from on-demand PrEP research.

 

I am not the only forum member, by the way, that applies the principle of 'caveat emptor' to all consumerism including health care. A physician incapable of drawing on more sophisticated processing in order to temper cognitive bias and short-sighted impressions of me would not pass my 'acid test' for patient-centred care.