Does intermittent PREP really work?

[socurious]

Is it 100% safe?

It is also known as “intermittent,” “non-daily,” “event-driven,” or “off-label” PrEP use. The type of “on-demand” PrEP that has been studied is the “2-1-1” schedule. This means taking 2 pills 2-24 hours before sex, 1 pill 24 hours after the first dose, and 1 pill 24 hours after the second dose.

[+ BenjaminNicholas]

There are several existing threads here about a 2-1-1 PrEP schedule.

Is it 100% anything?  No.  

What is does do is require more thinking about when/where and how.  Unlike the simplicity of one a day, with 2-1-1 you've got to keep up with a specific pill schedule.  Some people can easily handle this, while others can't even follow a one-and-done without threat of missing doses.  

It's really about what works best for you.  PrEP remains 99% effective against the transmission of HIV and reaches maximum protection at around 7 days after daily use.

[CheckCar]

I tried it and it didn’t work out for me because of one of the possible side effects: diarrhea 😞

I’m someone who plans encounters ahead of time—like way ahead of time—so the 2-1-1 regimen made a lot of sense to me. But alas, I had to rule it out because of that particular side effect. 

[jeezifonly]

Yep, diarrhea. I was on a regimen that included Truvada for a couple of years - Imodium helped!  The intermittent dosage saves money, as Prep is ‘resistant’ to insurance coverage 🤨 but if you haven’t planned as carefully as the pre/post regimen demands, you are at risk, so don’t forget condoms!

[Quincy_7]

How do you know that you're going to have sex within the next 24 hours though? Even when I've gone on my sex tourist vacations I didn't plan our my hiring schedule and I didn't hire every single day. It was very ad-hoc based on how much regular touristy stuff I'd checked off my list and how much time in the day I had left.

If a daily pill regimen sounds too tedious then just stick to condoms.

[SirBillybob]

On 3/27/2022 at 4:35 PM, Quincy_7 said:

How do you know that you're going to have sex within the next 24 hours though? Even when I've gone on my sex tourist vacations I didn't plan our my hiring schedule and I didn't hire every single day. It was very ad-hoc based on how much regular touristy stuff I'd checked off my list and how much time in the day I had left.

If a daily pill regimen sounds too tedious then just stick to condoms.

‘On demand’ is simply code for NOT long-term continuity. On sex-centric holidays it can be ‘on demand’ without truncating at 2:1:1 … for example, if I am away for 4 weeks I start with 1 Truvada per day for a week prior to travel or 2 primers within that frame but no later than 2 hours prior to first trick. Then 1 per day for the 4 weeks of play and 1 final Truvada 24 as well as 48 hours past the final trick. Typically all doses around the same time of day. And condoms are used reciprocally consistently as well. I do feel nauseous at times, and even very modest alcohol intake seems to exacerbate it, so if there is a substantial break (celibacy) within the vacation period I just use common sense as to stopping temporarily and trying to anticipate the need for a renewed 2-dose bioavailability priming. Or adjust if necessary by postponing intercourse.

Edited April 3, 2022 by SirBillybob

[CheckCar]

On 3/27/2022 at 10:35 AM, Quincy_7 said:

How do you know that you're going to have sex within the next 24 hours though? Even when I've gone on my sex tourist vacations I didn't plan our my hiring schedule and I didn't hire every single day. It was very ad-hoc based on how much regular touristy stuff I'd checked off my list and how much time in the day I had left.

If a daily pill regimen sounds too tedious then just stick to condoms.

I literally make appointments for sex. I rarely go out to bars, and when I do, I don’t pick up any guys. Also, since I’m very paranoid about making a mess, I fast for a day before having sex, which obviously takes planning.

For some of us, sex just isn’t a spontaneous thing. 

[+ FrankR]

On 3/24/2022 at 11:48 PM, jeezifonly said:

Yep, diarrhea. I was on a regimen that included Truvada for a couple of years - Imodium helped!  The intermittent dosage saves money, as Prep is ‘resistant’ to insurance coverage 🤨 but if you haven’t planned as carefully as the pre/post regimen demands, you are at risk, so don’t forget condoms!

I switched to Descovy and no longer have the stomach problems caused by Truvada.  If affordability is a concern, check out https://heymistr.com/  They will apply for patient assistance from the manufacturer on your behalf and in almost all cases it helps a great deal with affordability (in most cases free).  Doctors consultations and quarterly testing is included and free. 

That being said - I am not sure that Descovy is approved for non-daily Prep.  If you like that approach, you should probably stick with Truvada unless your doctor recommends it.

Edited April 4, 2022 by FrankR

[SirBillybob]

Addendum: I meant to write 2 Truvada primer doses 2 to 24 hours prior to first sex, not solely 2 doses within the week leading up. The week leading up would be one dose daily 

[+ sniper]

You guys know generic Truvada is on the market now, right? I think in the haze of the pandemic this didn't get nearly the news coverage it warrants. It's far, far cheaper now, and I assume less likely the insurer will put up a fight.

[SirBillybob]

2 hours ago, sniper said:

You guys know generic Truvada is on the market now, right? I think in the haze of the pandemic this didn't get nearly the news coverage it warrants. It's far, far cheaper now, and I assume less likely the insurer will put up a fight.

If you mean by generic not manufactured by Gilead but the same constituent elements tenofovir-emtricitabine I have been taking such versions for almost 3 years. 

[MikeBiDude]

8 hours ago, sniper said:

You guys know generic Truvada is on the market now, right? I think in the haze of the pandemic this didn't get nearly the news coverage it warrants. It's far, far cheaper now, and I assume less likely the insurer will put up a fight.

 

5 hours ago, SirBillybob said:

If you mean by generic not manufactured by Gilead but the same constituent elements tenofovir-emtricitabine I have been taking such versions for almost 3 years. 

Once my annual deductible kicks in, I think my generic Truvada is $3.07/month.

[Rudynate]

On 4/3/2022 at 3:45 PM, SirBillybob said:

‘On demand’ is simply code for NOT long-term continuity. On sex-centric holidays it can be ‘on demand’ without truncating at 2:1:1 … for example, if I am away for 4 weeks I start with 1 Truvada per day for a week prior to travel or 2 primers within that frame but no later than 2 hours prior to first trick. Then 1 per day for the 4 weeks of play and 1 final Truvada 24 as well as 48 hours past the final trick. Typically all doses around the same time of day. And condoms are used reciprocally consistently as well. I do feel nauseous at times, and even very modest alcohol intake seems to exacerbate it, so if there is a substantial break (celibacy) within the vacation period I just use common sense as to stopping temporarily and trying to anticipate the need for a renewed 2-dose bioavailability priming. Or adjust if necessary by postponing intercourse.

"Trick" - that's not a word  you here very much anymore.

[Rudynate]

On 4/11/2022 at 4:54 AM, sniper said:

You guys know generic Truvada is on the market now, right? I think in the haze of the pandemic this didn't get nearly the news coverage it warrants. It's far, far cheaper now, and I assume less likely the insurer will put up a fight.

It has been available from offshore for years.

[Hlparx]

On 4/11/2022 at 1:12 PM, MikeBiDude said:

 

Once my annual deductible kicks in, I think my generic Truvada is $3.07/month.

I think US insurers are required to cover at no cost to patient.

https://www.statnews.com/2021/09/02/hold-insurers-accountable-for-covering-hiv-prevention-drugs-at-no-cost-to-patients/

[MikeBiDude]

1 hour ago, Hlparx said:

I think US insurers are required to cover at no cost to patient.

https://www.statnews.com/2021/09/02/hold-insurers-accountable-for-covering-hiv-prevention-drugs-at-no-cost-to-patients/

I forgot to mention I’m on Medicare with a supplemental Rx plan. Before I turned 65 ( barely a year ago) my Truvada was essentially free, with Gilead program covering $50 co-pay. That program doesn’t apply to government insurance programs, so when I went on Medicare that co-pay program stopped. I’m content with my current plan and accept the fact it takes me 3-4 months to hit my annual deductible then everything is very inexpensive.

[marylander1940]

Unless someone has problems with his liver or kidney I would recommend take PrEP daily like most folks do. HIV is still a huge F@#ing deal!

[+ nycman]

The bottom line is that intermittent or "on demand" PREP is less effective than long term daily PREP.

Nonetheless, it’s infinitely better than taking nothing. 

If you’re an "everyday" or "spontaneous" whore….I’d advise daily PREP.

If you’re a "scheduled" or "vacation only" whore…I’d still advise daily, but offer "on demand". 

 

[Quincy_7]

On 4/18/2022 at 12:57 AM, nycman said:

The bottom line is that intermittent or "on demand" PREP is less effective than long term daily PREP.

Nonetheless, it’s infinitely better than taking nothing. 

If you’re an "everyday" or "spontaneous" whore….I’d advise daily PREP.

If you’re a "scheduled" or "vacation only" whore…I’d still advise daily, but offer "on demand". 

 

Where do condoms come in for you?

[+ nycman]

On 4/24/2022 at 9:55 PM, Quincy_7 said:

Where do condoms come in for you?

Everyone should be using condoms and PREP for every sexual encounter. 

I fully realize that this is not reality in 99% of today’s world…..but you asked…I told. 

[SirBillybob]

I don’t know exactly what “really” means here. Actually in truth, or a lot.

My sense is that the best approach is to define what satisfactorily working for you would look like, then explore the scientific data for a comparison with your requirements, expectations, etc.

Are you alluding to a comparator such as daily uptake, or are you inquiring about specific effectiveness of on-demand? Do you wish a handful of opinions about one format versus another, or are you thinking on-demand would be the better practical option for you, thus seeking info about that specific format to inform your choice about it?

I believe there are data that exist and are easily accessible on the public domain.

Also, by “safe” is what is meant effectiveness, or pharmacological adverse events? The 100% question does not clarify the direction of the inquiry.

Edited April 27, 2022 by SirBillybob