Anyone here on PrEP 2-1-1?

[Yeahman]

They are different.

 

The biggest thing being that they metabolize in completely different ways.

 

Is it the case that Descovy has less side effect and equally effective on a 2-1-1 regimen?

[Yeahman]

As long as you're comfortable doing that and he's receptive, that's awesome ?

 

So many docs don't keep up with where meds have gone (and are going). They're stuck in the 'take two amoxil a day and call the nurse on duty if it gets worse' ideology. That's why- for me- finding not only a gp, but also an infectious disease specialist has been the silver bullet.

 

Now I feel medically well-cared for and as an escort, that's perhaps the most important tool in our arsenal.

 

Thank you for being a responsible provider for yourself, your parents as well as your beloved clients.

[Guest]

I just received a letter from Gilead stating they are discontinuing the Truvada co-pay assistance (in California at least) bcs there is a generic replacement. I have paid zero for my Truvada for a few years now with insurance and Gilead co-pay. Apparently there is a co-pay program for Descovy.

 

I’ve not seen much info on the generic Truvada? My doctor is a bit clueless about my lifestyle, but I like him and it’s fun educating him on these drugs, lol.

 

A lot of gay and gay friendly doctors started switching their Truvada Prep patients over to Descovy for this very reason. They weren't convinced the new formula was all that better and could have new side effects but knew that as soon as Truvada went generic Gilead would discontinue the co-pay program.

[Yeahman]

i didn't read the other replies; i am sorry if this was answered

it is truvada

i have taken truvada everyday & via the 2-1-1 method & PEP twice (i'll answer any questions)

i tested negative for hiv on 9/14/20

i go on and off truvada for a variety of reasons

there are a lot of politics around truvada (unfortunately/fortunately)

there is a race between the sexual health departments of the major american cities to get new hiv infections to 0% (this is absolutely possible if they can get everyone on PrEP)

there are serious concerns within the medical communities about 2-1-1 confusing patients who are taking truvada daily and it causing doing more harm than good

the inner city systems (doctors, directors, management, etc) have a huge investment of time & energy getting high risk people to take their meds at all (keep in mind they are dealing with a % of people who are having unprotected sex w/ countless people everyday, addicts, struggle with metal health issues, homeless, etc so it skews how they view everyone and treatment for everyone) - if you look at the stats PrEP is working within those communities - this matters for the health of our communities and for funding

notice the talk of a vaccine or cure is basically non existent

hospitals clinics etc told (tell) patients PrEP has no serious side effects this is very controversial and all i will say is check in with the major universities like UCLA and read the reports/clinical studies

i realize some of this is a tangential (sorry), but it is important stuff that is not discussed enough

 

(1) So my guess is that when you are certain you won't be sexually active for a while, you will pause on the daily regimen, and switch to the 2-1-1 method?

 

(2) Did you have strong reaction to truvada when you first started on it? I have never taken any PrEP, so I'd like to know if I take it for 2-1-1, will it mess up my planned encounter.

 

(3) I read about people having horrible reactions to PEP. What was your experience?

[+ Snbrd]

Yeahman, I encourage you and other forum members to have a physician with whom you can be candid about your sex practices and who is culturally and medically current on gay health issues. It may be more challenging in rural areas and places with smaller gay populations but it matters. I am a bit more adventurous when traveling. It helps to be able to tell your doc what you did (baths, cruising areas, sex parties, and of course rentboys!) so he can advise you on STD tests, whether to get hep vaccines, etc.

[Rudynate]

That’s the other side of the coin. HIV isn’t very contagious but is extremely virulent, killing virtually 100% of its host population.

[+ Lucky]

Do consult with a trusted medical practitioner.

Wise, wise words. Do not get your medical plans from a message board.

[Yeahman]

That’s the other side of the coin. HIV isn’t very contagious but is extremely virulent, killing virtually 100% of its host population.

And it is cunning and tricky, that's why there is no vaccine.

[tenderloin]

The 2-1-1 method is more commonly used and accepted outside of the US. Many folks abroad say that our use of the daily pill approach is just another example of big pharma making sure that they can sell us more pills.. Not being a medical pro, I can't weigh in on the virtues of one approach versus the other. But as someone who has sex infrequently (twice or three times a month is a good month), I struggle to justify the daily pill regime and required frequent doctor visits.

Edited September 30, 2020 by tenderloin

[rustyrex]

I just received a letter from Gilead stating they are discontinuing the Truvada co-pay assistance (in California at least) bcs there is a generic replacement. I have paid zero for my Truvada for a few years now with insurance and Gilead co-pay. Apparently there is a co-pay program for Descovy.

 

I’ve not seen much info on the generic Truvada? My doctor is a bit clueless about my lifestyle, but I like him and it’s fun educating him on these drugs, lol.

 

Thanks for the info, my doc hasn't said a word about this. I remember hearing that Truvada is about to generic, but I didn't hear that Gilead is about to discontinue the assistance program. So far I haven't had to pay for Truvada but since it's about to change I may start the 2-1-1 method.

[Yeahman]

The 2-1-1 method is more commonly used and accepted outside of the US. Many folks abroad say that our use of the daily pill approach is just another example of big pharma making sure that they can sell us more pills.. Not being a medical pro, I can't weigh in on the virtues of one approach verse the other. But as someone who has sex infrequently (twice or three times a month is a good month), I struggle to justify the daily pill regime and required frequent doctor visits.

 

2 to 3 times a month is pretty frequent. I only do it once or twice a year on average. So I have no reason to take it every day.

[MikeBiDude]

Thanks for the info, my doc hasn't said a word about this. I remember hearing that Truvada is about to generic, but I didn't hear that Gilead is about to discontinue the assistance program. So far I haven't had to pay for Truvada but since it's about to change I may start the 2-1-1 method.

I’m going to renew at pharmacy next time and just see what happens? If they charge the $50 copay I’ll pay it and research options more closely.

[Yeahman]

Wise, wise words. Do not get your medical plans from a message board.

 

True. Always consult professionals before taking your med. But I still value member discussions.

[thedanNYC]

2 to 3 times a month is pretty frequent. I only do it once or twice a year on average. So I have no reason to take it every day.

 

If I may ask, are you considering using PrEP together with a condom to be extra safe since you only have sex once a year and don't want to take any risks? Or are you considering PrEP so you can have sex without a condom?

 

If it's the latter, risking contracting other STDs, such as herpes, during a once-a-year encounter (presumably with a stranger) seems like an interesting choice to me. Are you taking that risk because it gives you a better sense of intimacy?

[Rudynate]

And it is cunning and tricky, that's why there is no vaccine.

 

 

When I first leaned about viruses in college biology, they weren’t considered to be living organisms because they didn’t meet all the requirements to satisfy the accepted definition of a life form. Since then, the understanding has changed and viruses are now considered living organisms.

[Yeahman]

If I may ask, are you considering using PrEP together with a condom to be extra safe since you only have sex once a year and don't want to take any risks? Or are you considering PrEP so you can have sex without a condom?

 

If it's the latter, risking contracting other STDs, such as herpes, during a once-a-year encounter (presumably with a stranger) seems like an interesting choice to me. Are you taking that risk because it gives you a better sense of intimacy?

 

Always safe only. Protected. Wrapped up.

[thedanNYC]

When I first leaned about viruses in college biology, they weren’t considered to be living organisms because they didn’t meet all the requirements to satisfy the accepted definition of a life form. Since then, the understanding has changed and viruses are now considered living organisms.

 

By whom? Viruses are certainly considered more than simply inert matter, given that they have the potential to become "alive" if and when they hijack the proper biological mechanisms. In that way, they're not not alive like a rock is. But I don't think there's absolute consensus in the scientific community on whether viruses should be thought of as being "alive."

 

*waits for the scientists and doctors to chime in

[+ sniper]

It's a philosophical question really.

[thedanNYC]

Always safe only. Protected. Wrapped up.

 

Gotcha. You're going with the belt and suspenders approach. Very sensible.

[+ sniper]

I think the quesion of "alive" used to involve does something eat/excrete/reproduce and since viruses only reproduce they were not regarded as "alive."

[Rudynate]

By whom? Viruses are certainly considered more than simply inert matter, given that they have the potential to become "alive" if and when they hijack the proper biological mechanisms. In that way, they're not not alive like a rock is. But I don't think there's absolute consensus in the scientific community on whether viruses should be thought of as being "alive."

 

*waits for the scientists and doctors to chime in

 

I would be very surprised if there weren't a consensus that viruses are living organisms.

[Yeahman]

Gotcha. You're going with the belt and suspenders approach. Very sensible.

Exactly.

[down_to_business]

The linked chart is much easier to read. I found it helpful as this thread was the first I heard about this.

 

https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/PrEP211_101019_ADA.pdf

 

“On-Demand” Pre-Exposure Prophylaxis (PrEP) for Sexual Intercourse PrEP 2-1-1 or “On-Demand” PrEP is a non-daily PrEP dosing strategy that has been evaluated in men who have sex with men (MSM) and was 86% effective at preventing HIV transmission in a clinical study in Canada and France. The PrEP 2-1-1 protocol shown below is not FDA-approved; however, PrEP 2-1-1 has been endorsed by the International AIDS Society USA.

 

What is the Difference Between PrEP and PrEP 2-1-1?

Daily PrEP is the FDA-approved use of a daily pill (Truvada® or Descovy®) that combines two drugs to prevent HIV transmission. Many studies have shown that it can reduce the risk of HIV transmission by up to 99%. Studies have been done proving PrEP is effective for men, women, and transgender people, as well as preventing transmission through injection drug use. The United States Prevention Task Force has given PrEP Grade A status.

The PrEP 2-1-1 dosing strategy has not been FDA approved but has been studied with Truvada® and shown to be an effective HIV prevention choice for MSM. PrEP 2-1-1 can prevent HIV transmission during anal sex. PrEP medication absorbs slower into vaginal tissue than anal tissue, so PrEP 2-1-1 is not an effective option for vaginal sex. PrEP 2-1-1 can be an option for people who have less frequent anal sex or for people who are unable or prefer not to take daily PrEP.

 

How Does PrEP 2-1-1 Work?

PrEP 2-1-1 starts by taking TWO pills between 2 and 24 hours before sex. Taking the pills closer to 24 hours before sex is better but you can use PrEP 2-1-1 up to 2 hours before sex. After sex, you take ONE pill 24 hours after the first pills, and ONE pill again 24 hours after that. That’s PrEP 2-1-1, get it?

 

Take TWO pills 2 – 24 hours before sex. If you know when you’ll have sex, take the pills closer to 24 hours before sex.

Take ONE pill 24 hours after the first dose.

Take ONE pill 48 hours after the first dose.

 

Important Note: The PrEP 2-1-1 dosing schedule changes if you are going to have sex within seven days of your last PrEP dose. Start by taking just ONE pill between 2 and 24 hours before sex. You still take ONE pill 24 hours after the first pill, and ONE pill again 24 hours after that.

 

Daily PrEP has extensive clinical trial data on safety and efficacy and is the only dosing strategy recommended by the CDC.

The State Office of AIDS recommends PrEP and financial assistance may be available through California’s PrEP-Assistance Program (PrEP-AP) for uninsured and insured individuals who meet the eligibility criteria.

PrEP 2-1-1 has only been studied in MSM. There is no data and it is not recommended for use in cis-women, cis-men who have sex with women, transgender women and men, people who inject drugs, or people with active hepatitis B coinfection.

The PrEP 2-1-1 protocol with Truvada® is the only non-daily strategy with evidence for HIV prevention. PrEP 2-1-1 with Descovy® is not recommended outside of a clinical trial.

PrEP 2-1-1 should be prescribed by a healthcare provider and should include HIV and STI testing at least every 3 months.

People considering PrEP 2-1-1 should be able to plan or delay their sexual activity so that their first dose is at least 2 hours (and preferably closer to 24 hours) before sex.

 

Select Clinical Trials and References: IPERGAY (Molina et al. NEJM 2015): 400 MSM (France, Canada) randomized to PrEP 2-1-1- vs. placebo. 86% efficacy. Participants took median 15 pills per month. IPERGAY open label extension (Molina et al. Lancet HIV 2017): only one HIV infection detected in 361 MSM over 18 months follow-up.

[+ robear]

I’m going to renew at pharmacy next time and just see what happens? If they charge the $50 copay I’ll pay it and research options more closely.

@MikeBiDude I can't speak to your coverage, of course, but in my experience when generic drugs become newly available, my pharmacy manager shifts over automatically unless the prescription is written "Dispense As Written", which I don't think doctors generally do.

[MikeBiDude]

@MikeBiDude I can't speak to your coverage, of course, but in my experience when generic drugs become newly available, my pharmacy manager shifts over automatically unless the prescription is written "Dispense As Written", which I don't think doctors generally do.

That would be ok with me!