Prep and pep

[Pittlookalike]

Excuse my naivete.  While I’m hiv negative, I’ve never taken prep or pep as I’ve not engaged in unsafe sex.  But I’m about to have planned unprotected intercourse.  So i want to take prep and pep.  Some questions:

1.  What amount of time (days) before my unprotected sex, do i start prep?   And for what amount of time after my unprotected sex do i continue to take prep?

2. I also want to take pep after the unprotected sex.  Any harm to taking both prep and pep?   For what amount of time after unprotected sex do i take pep?

3  prep and pep are just generic terms for the type of pills, correct?   What prep and pep pills are recommended?

 

thx much

 

[+ FrankR]

1 hour ago, Pittlookalike said:

Excuse my naivete.  While I’m hiv negative, I’ve never taken prep or pep as I’ve not engaged in unsafe sex.  But I’m about to have planned unprotected intercourse.  So i want to take prep and pep.  Some questions:

1.  What amount of time (days) before my unprotected sex, do i start prep?   And for what amount of time after my unprotected sex do i continue to take prep?

2. I also want to take pep after the unprotected sex.  Any harm to taking both prep and pep?   For what amount of time after unprotected sex do i take pep?

3  prep and pep are just generic terms for the type of pills, correct?   What prep and pep pills are recommended?

 

thx much

 

You REALLY need to consult a medical professional.

[+ robear]

Fully agree with FrankR, that you need to see a doctor and get clear on this under his/her care.

However, a few broad aspects of this (I am not a medical professional, I am on PrEP and have been for several years.)

In the US, the 2 drugs (combos of two drugs actually, emtricitabine and tenofovir) used for PrEP are Descovy and Truvada. They are both one pill daily. Descovy is newer and generally preferred because it's "lighter" in medication, the big whammy of Truvada isn't deemed necessary, although Truvada is available as a generic so your choice may be informed by what's available to you.

PrEP is taken on an ongoing basis, it's strongly advised NOT to stop and start based on your sexual activity.  Once you're on it, you stay on it.  Most people report no side effects, or other impediments to taking it (other than availability/affordability if that's an issue).

PEP is essentially the same thing but calibrated for suspected post-exposure.  I believe the regimen is higher dosing, and may involve another drug.  Many have reported that a course of PEP can be difficult to take, with unpleasant side effects.  The two approaches aren't combined.  Get on PrEP, stay on PrEP, that's it.

Guidance that I've seen is that it takes 10 days of daily dosing of Descovy or Truvada for full protection.  Obviously that's an estimate, but the key is not to assume you are fully protected tonight if you took your first pill this morning, your body has to ramp up to full protection.

But please do all of this with a trusted physician, or at least a provider from a sexual health clinic, to make sure you're clear on your situation and options.

[Pittlookalike]

Thx robear. Yes I’ll speak with my doctor but wanted to hear what others say.  

[+ BenjaminNicholas]

11 hours ago, FrankR said:

You REALLY need to consult a medical professional.

This. 

You don't need to consult a message board. 

You need a good doctor to guide you and prescribe the right RX. 

It's not about what other folks do... It about what's best for you and your sexual health. 

[+ nycman]

Get on Prep.

Stay on Prep.

Use condoms.

Everything else is playing with fire.

[JonathanCAN]

On 8/15/2022 at 9:57 AM, Pittlookalike said:

Excuse my naivete.  While I’m hiv negative, I’ve never taken prep or pep as I’ve not engaged in unsafe sex.  But I’m about to have planned unprotected intercourse.  So i want to take prep and pep.  Some questions:

1.  What amount of time (days) before my unprotected sex, do i start prep?   And for what amount of time after my unprotected sex do i continue to take prep?

If you are on daily PrEP, then ... every day. Research shows it takes about 7 days or so for the anal tissue to have the maximum protection from daily PrEP.

Alternatively, there is also PrEP on Demand. You can read more: https://www1.nyc.gov/assets/doh/downloads/pdf/ah/prep-on-demand-dosing-guidance.pdf

On 8/15/2022 at 9:57 AM, Pittlookalike said:

2. I also want to take pep after the unprotected sex.  Any harm to taking both prep and pep?   For what amount of time after unprotected sex do i take pep?

You can't do both PrEP and PEP at the same time. PEP also has Truvada or Descovy as one of the regimen so you can't do both at the same time (plus if you are correctly dosing on PrEP, you wouldn't need PEP anyway)

If you need PEP, ASAP is the correct answer but in any case, no more than 48-72 hours after the sexual encounter.

On 8/15/2022 at 9:57 AM, Pittlookalike said:

3  prep and pep are just generic terms for the type of pills, correct?   What prep and pep pills are recommended?

 

There are only 3 PrEP approved: Truvada, Descovy and Apretude. The last is the newest, and is a depot injection that will last about 2 months (after initially with the pill trial to ensure tolerance). 

PEP formulary will be based on what is approved in your jurisdiction. You don't have a choice in that regard. 

[thedanNYC]

On 8/16/2022 at 8:39 PM, JonathanYVR said:

 

If you need PEP, ASAP is the correct answer but in any case, no more than 48-72 hours after the sexual encounter.

 

Very that. If you have a need for PEP after hours, you can generally go to an ER and get the first dose (and a few days' worth of pills) so that you can start treatment immediately while you fill the rest of the prescription.

[+ sniper]

I asked my primary care provider about PreP and she said she hadn't prescribed it before(I'm out in the burbs) and needed to look into whether dosage was weight dependent. Does anyome know if it is? E.g. does a 300 lb man require a higher dose than a 150 lb man for effectiveness.?

[SirBillybob]

5 hours ago, sniper said:

I asked my primary care provider about PreP and she said she hadn't prescribed it before(I'm out in the burbs) and needed to look into whether dosage was weight dependent. Does anyome know if it is? E.g. does a 300 lb man require a higher dose than a 150 lb man for effectiveness.?

The dosage is standard and the same for adults of all weights. 

[JonathanCAN]

10 hours ago, sniper said:

I asked my primary care provider about PreP and she said she hadn't prescribed it before(I'm out in the burbs) and needed to look into whether dosage was weight dependent. Does anyome know if it is? E.g. does a 300 lb man require a higher dose than a 150 lb man for effectiveness.?

Point your clinician to this: https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf

[AZNBoyNYC]

On 8/15/2022 at 12:57 PM, Pittlookalike said:

Excuse my naivete.  While I’m hiv negative, I’ve never taken prep or pep as I’ve not engaged in unsafe sex.  But I’m about to have planned unprotected intercourse.  So i want to take prep and pep.  Some questions:

1.  What amount of time (days) before my unprotected sex, do i start prep?   And for what amount of time after my unprotected sex do i continue to take prep?

2. I also want to take pep after the unprotected sex.  Any harm to taking both prep and pep?   For what amount of time after unprotected sex do i take pep?

3  prep and pep are just generic terms for the type of pills, correct?   What prep and pep pills are recommended?

 

thx much

 

1. You need to take the daily PreP for about 2 weeks before unprotected sex to provide adequate protection. You need to continue the PreP for at least 2 more weeks to be on the safer side provided you do not have unprotected sex after the first encounter. There is a new kind of PreP that requires only an injection every 2 months and they claim to have better protection. However, you need to get your insurance approve for it which can be tricky for some plan.

2. PEP is only for exposure with high risk (being bottom and unprotected), the side effects can be quite bad and you need to continue the completion course of the PEP which is a few weeks. If you already take PreP, the doc at emergency department will not recommend you do PEP.

3. PreP currently has 3 options: For daily pills you will have Truvada or Descovy (or their generic versions). Descovy is newer and is claimed to have less side effects and impact to liver, however it is also more expensive as there is no generic version yet. Most insurance plan will approve Descovy if you doc submit a request. For injection, the brand is Aperture, it is very expensive and most insurance plan only approve it if you are high risk (have multiple unprotected partners etc) but it only needs 1 injection monthly for first 2 times and then 1 injection every 2 months after that. The major side effect for the injection is pain at injection site but many feel it is much better trade off than taking a pill daily. 

[Pittlookalike]

3 hours ago, AZNBoyNYC said:

1. You need to take the daily PreP for about 2 weeks before unprotected sex to provide adequate protection. You need to continue the PreP for at least 2 more weeks to be on the safer side provided you do not have unprotected sex after the first encounter. There is a new kind of PreP that requires only an injection every 2 months and they claim to have better protection. However, you need to get your insurance approve for it which can be tricky for some plan.

2. PEP is only for exposure with high risk (being bottom and unprotected), the side effects can be quite bad and you need to continue the completion course of the PEP which is a few weeks. If you already take PreP, the doc at emergency department will not recommend you do PEP.

3. PreP currently has 3 options: For daily pills you will have Truvada or Descovy (or their generic versions). Descovy is newer and is claimed to have less side effects and impact to liver, however it is also more expensive as there is no generic version yet. Most insurance plan will approve Descovy if you doc submit a request. For injection, the brand is Aperture, it is very expensive and most insurance plan only approve it if you are high risk (have multiple unprotected partners etc) but it only needs 1 injection monthly for first 2 times and then 1 injection every 2 months after that. The major side effect for the injection is pain at injection site but many feel it is much better trade off than taking a pill daily. 

Thanks much.  My doctor said much of the same. 

[TorontoDrew]

Don't forget that HIV is not your only exposure from unprotected sex.  STIs are a major problem and some are becoming drug resistant.  

[Guest]

On 9/12/2022 at 4:53 AM, AZNBoyNYC said:

...Descovy is newer and is claimed to have less side effects and impact to liver, however it is also more expensive as there is no generic version yet. Most insurance plan will approve Descovy if you doc submit a request....

Descovy is merely a slight tweak in one of the two ingredients on Truvada. Descovy is a mixture of tenofovir alafenamide and emtricitabine (TAF/emtricitabine),  and Truvada is a mixture of tenofovir disoproxil fumarate and emtricitabine (TDF/emtricitabine). the purported benefit of the TAF (Descovy) is a slight safety benefit towards the kidneys and the bones (osteoporosis). I've never heard of the liver as being involved. Side-effects are similar, with only minor differences (Descovy with minor weight gain, Truvada with minor weight loss), as one might expect for two virtually identical meds. 

Unless those working for the insurance company are complete idiots, getting Descovy approved would involve documenting why the $1800/month medication is needed instead of the $45/month medication. The purpose of the prior authorization process is for the doctor to document why a costly treatment is necessary instead of the established treatment. The purpose is not to just harass the physician or to prove the physician really cares about you. If there is documentation in your record of osteoporosis or kidney disease, those would be legitimate reasons the Descovy/TAF would be approved. Even then, the difference is questionable....

https://www.aidsmap.com/about-hiv/truvada-or-descovy-which-should-i-take-prep

"...To summarize, those taking TDF/emtricitabine had less favorable outcomes in relation to kidney function and bone mineral density, while those on TAF/emtricitabine put on more weight and had poorer cholesterol outcomes.

However, medical experts concluded that the observed changes were generally so small as to not result in actual illnesses. A systematic review of TDF/emtricitabine used as PrEP by thousands of trial participants found no differences in kidney or bone harms compared with a placebo (i.e. no treatment). Furthermore, over 200,000 people have taken TDF/emtricitabine in the United States without any serious toxicities being reported...".

Edited September 18, 2022 by Unicorn