Thoughts on Prep via injection

[ICTJOCK]

So I switched over to the 6 month  prep  "injection" in March after my new insurance provider wouldn't pay for "Descovy" this year.   My doctor suggested the 6 month injection (as my provider  WOULD pay the cost of getting that,   go figure).   Getting the prep injection isn't alot of fun.  2 injections kind of at the side of your lower stomach or abdomen area and it hurt for a week.    I've been fine since,  but my next round is in about a week.   Just curious if there are others here who get the injection and thoughts on your experience.    I asked my doctor if many in the clinic get prep this way and she said I was the 3rd patient.    Interesting.

[Johnnyroad]

You might be receiving what is called Lenacapavir- something designed to be injected every 6 months.

I receive Apretude injections, which as far as I know, anre  administered near the buttocks area every two months. I have only received it twice up until this point.
 

Each time, I get nausea and diarrhea that lasts a day post injection, as well as soreness and muscular pain around the site of injection for around a week. 

[chitownguy]

I also have been getting the Aperture injections every 2 months for the last 18 months.  I haven't had any side effects other than soreness at the injection site.  That only lasts a few days.  The injection can either be administered in the center of your butt cheek or on the side just below your hip.  I usually get it in the side because the soreness is less for me.

Edited September 4 by chitownguy
correction

[Petris Sage]

Why would it be injected into the abs?

[moonlight]

3 hours ago, Petris Sage said:

Why would it be injected into the abs?

It's injected into abdominal subcutaneous tissue (Yeztugo). That's a common spot for subcutaneous injections (Apretude, in contrast, goes into muscle).

Edited September 5 by moonlight

[Wings246]

One of the notorious & common side effects of Yeztugo is the development of a firm lump/nodule at the injection site that can potentially last up to a year.  @ICTJOCK: do you notice the lump/nodule after the pain subsides?

[+ sniper]

My only concern with the injection is what is the confidence interval on how long it lasts? With a daily pill taken faithfully you know for sure you have some level of medication in your bloodstream. What if for whatever reason your body processes the injectable in 5 months instead of 6? How would you know? So I'm sticking to the pill for now. 

[Colton]

8 minutes ago, sniper said:

What if for whatever reason your body processes the injectable in 5 months instead of 6?

I'm also sticking with the pill, but I'm pretty sure someone at the FDA and the drug company thought about this.  This isn't their first injectable medicine.  The confidence interval you are looking for is probably in the studies.  Also the dosage has to work for people of different shapes and sizes, so its probably sized for the bear to be safe, not the twink.

Both drugs say that they stay in your bloodstream for 12 months or more after the injection date, and there is a 2-4 week window for your next shot, not a hard cutoff at exactly 6 months when you lose immunity.  

[+ SirBillybob]

Worry that replacing daily oral PrEP with an injectable might sacrifice protection as the injection concentration declines toward the next dose is understandable but isn’t supported by the clinical results. The approved intervals were deliberately set so that drug levels remain adequate through the end of the interval; the downward concentration curve is expected and already built into the regimen. 

There is no demonstrated end-of-cycle falloff in protection when injections are received on schedule. However, against perfectly taken oral PrEP, the biological advantage, in spite of statistically demonstrated superiority, may be small or unknowable because both approaches are already extremely effective. That said, Yeztugo trials were open label and there is no way to determine whether research subjects adjusted exposure risk towards dosing cycle finish lines. None of these methodologies are flawless. 

The idea suggested upthread, as basis for caution held by some making decisions, is confidence in a pharmacokinetic dosing protective buffer … 

“Confidence interval” does not refer to the degree of confidence in protection based on dosing intervals. In this context, confidence attaches to an estimated trial effect, often a hazard ratio or incidence-rate ratio describing sampling uncertainty around the overall comparative incidence of infection, for example Apretude compared to TDF/FTC (aka Gilead’s pre-generic Truvada), or Yeztugo compared to background population incidence. To illustrate, one trial with Apretude compared to TDF/FTC: about 66% lower HIV incidence; hazard ratio 0.34 (95% confidence interval 0.18-0.62). Not to be confused with time windows and waning protection.

My preference for oral PrEP, even if no out-of-pocket for injectable versions were possible, is based on my capacity for 100% adherence, but it’s moot because I apply that capacity to on-demand uptake. 

Edited 3 hours ago by SirBillybob

[Wings246]

Its official website is overloaded with info for both patients and scientists / healthcare providers (https://www.yeztugo.com/ and https://www.yeztugohcp.com/)

Here's the info for the drug depot: https://www.yeztugohcp.com/innovation#drug-depot

Clinical trials show 99.9% effectiveness: https://www.yeztugohcp.com/efficacy

That may be the reason why some researchers go as far as claiming that if this drug is widely available and used, it can play a significant role in ending the HIV epidemic.  This sounds like a far-fetched idea, but who knows?

Edited 7 hours ago by Wings246

[mtaabq]

If Prep were the only pill I had to take daily  I might feel differently. But at my age I have daily buffet of 5 pills all contained neatly in my pill caddy so, for me, that’s the best way to go. Meaning I’m less likely to miss a day. The physician at my last visit to the Men’s Health Clinic suggested the injectable. I’m glad it’s an option (the injectable). Thanks for the info, guys; I’m grateful for the exchange of ideas here. 

[Wings246]

2 minutes ago, mtaabq said:

I have daily buffet of 5 pills all contained neatly in my pill caddy so, for me, that’s the best way to go.

Of course, whichever method that ensures the maximum compliance rate is the best method.  Plus, I'd say most people prefer a tablet to a needle stick.

[mtaabq]

Just now, Wings246 said:

Plus, I'd say most people prefer a tablet to a needle stick.

THAT is an excellent observation. I don’t mind a needle stick, but I know a lot of people who do. 

[+ SirBillybob]

And while we are clarifying “confidence interval” meaning, the lower 95% confidence interval bound for efficacy was 96.6% for Yeztugo in the PURPOSE 1 study; 82% in the PURPOSE 2 study. 

Edited 6 hours ago by SirBillybob

[la_connor]

My doc said he recommends the injection to geriatric patients who sometimes forget to take their pills.