To PrEP or not to PrEP? Is that the future? Should we give up condoms and surrender?

[marylander1940]

To PrEP or not to PrEP? Is that the future? Should we give up condoms and surrender? I won't!

 

I know, it's an old subject but here we go talking about it on a monthly basis.

 

"I assume we are all mature enough to admit no one actually uses condoms anymore. .. so just get on PREP already."

 

http://www.adam4adam.com/?p=32texas

 

Pre-exposure prophylaxis, or PrEP, is a prevention option for people who are at high risk of getting HIV. It’s meant to be used consistently, as a pill taken every day, and to be used with other prevention options such as condoms. Find out if PrEP is right for you.

 

http://www.cdc.gov/hiv/basics/prep.html

[+ purplekow]

Those who do not learn from the past are doomed to repeat it.

[Steven_Draker]

PrEP is not for everyone.

 

If you're in a high risk group, you fail to use condom each time you have sex, you bottom, you're taking risk often, you should definitely talk to you doctor and consider Pre-Exposure Prophylaxis.

 

http://www.cdc.gov/hiv/prevention/research/prep/

[+ SimplyAdam]

I just began PrEP in December, and am still going through those LifeStyles and Trojans without fail.

 

PrEP is the only pharmaceutical pill I pop - and I take it hesitantly, as I'm wary of the long-term repercussions - but it's extra security, and only one I'm embracing given that sex workers who bottom regularly are certainly in that "high risk group." If I were just a cautious, sex-positive gay guy, I wouldn't have a prescription.

 

And for what it's worth, I'm not a total anomaly in that I've never not used a condom in almost 14 years of having anal sex. Not once. I used to say I wouldn't go uncovered until I found true love. Now I think I'll just hold out until we have (access to) a vaccine or a cure.

[marylander1940]

I just began PrEP in December, and am still going through those LifeStyles and Trojans without fail.

 

PrEP is the only pharmaceutical pill I pop - and I take it hesitantly, as I'm wary of the long-term repercussions - but it's extra security, and only one I'm embracing given that sex workers who bottom regularly are certainly in that "high risk group." If I were just a cautious, sex-positive gay guy, I wouldn't have a prescription.

 

And for what it's worth, I'm not a total anomaly in that I've never not used a condom in almost 14 years of having anal sex. Not once. I used to say I wouldn't go uncovered until I found true love. Now I think I'll just hold out until we have (access to) a vaccine or a cure.

 

you're a smart guy!

[Rudynate]

I started PrEP in December and stopped after 5 weeks. Couldn't tolerate it. It made me feel tired and lethargic all the time. I would sleep deeply for 8 or 9 hours every night and wake up not feeling rested. After 5 weeks, I realized I couldn't stand feeling that way for even another day.

 

I'm a big believer in it, though. As soon as there's another PrEP agent besides Truvada, I will try it again.

[Steven_Draker]

I've never not used a condom

 

http://2.bp.blogspot.com/-LyAszRAI6jU/UHm4AZIY-WI/AAAAAAAAAjw/UntFoqdQ8xE/s1600/Snarky_bart.jpg

 

[+ Chris Eisenhower]

I started PrEP in December and stopped after 5 weeks. Couldn't tolerate it. It made me feel tired and lethargic all the time. I would sleep deeply for 8 or 9 hours every night and wake up not feeling rested. After 5 weeks, I realized I couldn't stand feeling that way for even another day.

 

I'm a big believer in it, though. As soon as there's another PrEP agent besides Truvada, I will try it again.

 

I worry about the potential side effects, and don't want to be that disabled person sitting at home watching "Maury" when the inevitable "Have you been injured by Truvada or PrEP? Call the law office of... " commercial comes on.

 

No thank you. And as I've said before—there's other stuff to worry about besides HIV.

[down_to_business]

Gilead's Pill Can Stop HIV. So Why Does Almost Nobody Take It?

 

.

 

Bloomberg

By Caroline Chen

February 18, 2015 12:01 AM

 

 

(Bloomberg) -- Gilead Sciences Inc. may be one of the first drugmakers in history to have people asking why it’s not doing more to pitch its medicine.

 

 

Truvada, Gilead’s HIV drug, has been approved since 2004 for people with the virus. In 2012, use was expanded to people without HIV as a way of preventing transmission -- a practice called PrEP, or pre-exposure prophylaxis. Taken daily, it can prevent infections 92 percent of the time, meaning it could drastically reduce new infections in sexually active gay men, among the U.S.’s highest-risk communities.

 

Thanks to its use in HIV patients, Truvada’s been a financial success, bringing Gilead $1.79 billion in the U.S last year. Yet out of 3.3 U.S. million prescriptions from January 2012 to March 2014, only 3,200 were for prevention.

 

There are many reasons: Gilead says PrEP isn’t a moneymaker, so the drugmaker doesn’t pitch the medicine to many of the primary care doctors who see healthy, HIV-negative gay men most likely to benefit from Truvada. Patients and advocates say doctors often don’t know about the medicine, and some insurance plans leave patients with copays as high as $1,300, making use by the healthy less affordable.

 

The result is thousands of people who could significantly lower their HIV risk, yet don’t. Some 50,000 Americans are diagnosed with HIV each year, with the highest rates among young gay males, according to the U.S. Centers for Disease Control and Prevention.

Yet in November, Gilead said that 42 percent of PrEP prescriptions written through March 2014 were for women, and only 7.4 percent were for men younger than 25.

 

‘Pointing Fingers’

Peter Jirak, a gay, 42-year-old software engineer in Minneapolis, first heard about Truvada on the radio. When he went to his doctor, she told him she’d never prescribed it. He had to go to a specialist to get the medicine.

 

“There’s a circle of pointing fingers,” said Jim Pickett, director of prevention advocacy and gay men’s health at the AIDS Foundation of Chicago. “HIV specialists are like, ‘I don’t see HIV-negative people,’ and you see a primary care physician, and they say, ‘You need to see a specialist.’”

 

The drugmaker’s sales force is focused on HIV specialists, not primary care doctors who see healthy people. Gilead “does not view PrEP as a commercial opportunity and is not conducting marketing activities around Truvada as PrEP,” said Cara Miller, a spokeswoman. Instead, the Foster City, California, company supports more than 50 community organizations around the U.S., paying for educational efforts.

 

 

 

 

Outside the Bubble

Gilead’s funding “is great, and necessary work,” said Pickett. Yet Gilead “reps have access to doctors and nurses who are not in the HIV bubble -- and if they would engage with them around Truvada as PrEP, we’d have a lot more providers aware and educated.”

 

Truvada interferes with a protein called reverse transcriptase, which is used by HIV-infected cells to make copies of the virus. The high number of female users are possibly married to HIV-positive partners and trying to get pregnant, according to Susan Buchbinder, an epidemiologist at UCSF who works with the San Francisco Department of Public Health. Gilead said prescriptions for men started rising in 2013.

 

Buchbinder said she’s hopeful that, over time, uptake will increase among men, and that she’s already seeing a substantial rise in prescriptions in San Francisco. Reaching even a fraction of high-risk patients could make a difference. A paper published in the Annals of Internal Medicine predicted that initiating PrEP in 20 percent of men who have sex with men could reduce new U.S. HIV infections by 13 percent.

 

Affordable?

 

While Truvada is covered by insurers, it can come with copayments that make it unaffordable compared to condoms. Depending on insurance plan, PrEP can cost as little as $20 a month, or hundreds.

 

Gilead’s assistance program covers as much as $300 a month, helping 93 percent of participants lower their monthly out of pocket expenses to under $25, according to Miller. The program helped Jirak bring his $140-a-month copay to $0.

 

“$140 is enough that it would cause me to pause and say, ‘Do I benefit enough from the medicine?’” he said.

 

Others pay more, especially in the lowest-level plans under the Affordable Care Act, which can feature high up-front costs. David Evans, director of research advocacy at San Francisco-based Project Inform, an advocacy group for people with HIV/AIDS, said that he’s worked with patients who have seen initial bills of $1,300 a month before full coverage kicks in.

Make or Break

Carlos Coronado, a 32-year-old nursing assistant in New York City, said his privately run Medicaid plan wouldn’t cover PrEP. To get the drug, he enrolled in two clinical trials that will give him 18 months’ worth.

 

After that, his access to the drug will depend on his new insurance. “Copay affordability will make or break my ability to stay on PrEP,” he said in an online message.

 

Some people seeking Truvada are also facing judgment from doctors.

 

“The assumption is, if you’re using Truvada to prevent HIV, you’re engaging in fabulous orgies while high on meth,” Jirak said.

 

He says he’s responsible yet lives in the real world. “Most of us will have some amount of sex without condoms under some circumstances,” he said. “Compliance with condom use requires one think logically and rationally when one is right about to have sex -- when one’s mind is least likely to think logically and rationally.”

 

Safe Sex

He’s had multiple past partners who are HIV positive. “I am in a relationship. The advantage to Truvada as PrEP is that it allows us to be unconcerned about HIV.”

 

In a vacuum without a large group of knowledgeable doctors or Gilead’s efforts to do wider education, much of the work has been left to patients and advocates. PrEP Facts, a Facebook group with more than 5,400 members, keeps lists of doctors in major cities known to prescribe the drug.

 

In the meantime, patients have to teach the rest. Bruce Kleinschmidt, a 62-year-old attorney in Louisville, Kentucky, said his physician had never heard of Truvada. His doctor agreed to prescribe the drug, though he questioned the need for regular lab tests for STDs and to monitor liver function until Kleinschmidt returned with information from the CDC.

 

Despite all the barriers, many PrEP users say that working through the obstacles is worth it, and having peace of mind is invaluable.

 

“It’s taken away the worry, when I get an HIV test I don’t have that knot in my stomach or cold sweat waiting for the results to come back,” said John Lee, a 37-year-old retail manager in Nashville, Tennessee.

 

For Kleinschmidt, the pill brings back memories of now-dead friends he met through decades of pro-bono work with AIDS patients. “I buried so many friends, it’s unbelievable,” he said. “I quit counting at 25.”

 

In the first weeks after he received his prescription, he had a daily ritual. “I would hold up the pill and think of a dead friend, and say, ‘I’m taking this for you. God, I wish it was around to have helped you.’”

 

To contact the reporter on this story: Caroline Chen in San Francisco at [email protected]

 

To contact the editors responsible for this story: Crayton Harrison at [email protected] Drew Armstrong, John Lear

[bostonman]

I worry about the potential side effects, and don't want to be that disabled person sitting at home watching "Maury" when the inevitable "Have you been injured by Truvada or PrEP? Call the law office of... " commercial comes on.

 

True. I hate those ads. Lately it seems to be all about boys growing breasts and women suffering the effects of "power morcellators" (I never knew there was such a thing, and kinda wish I still didn't). I know they have to put those ads out there, and obviously it's horrible for the people that have had those complications, but there has to be a better way to get the word out...

[+ purplekow]

www.consultant360.com/topic/infectious-disease[/url]

 

Granted this is from a so-called "throw away" journal, a journal sent for free and without subscription to many doctors and hospitals. Still it is interesting for our colleagues traveling to Cuba. Though not directly linked to the value of PrEP, it does make one wonder just how long PrEP will work against rapidly progressive strains and resistant strains.

[Guest ChrisW]

Has anyone else noticed its always the same people who comment about this and its always the same tired argument for not using? We can always rely on purple cow to be the doomsayer of the group too "were all gonna die!!!!"

[bostonman]

We can always rely on purple cow to be the doomsayer of the group too "were all gonna die!!!!"

 

Yes, but AREN'T we all gonna die? I mean, when they find a drug for immortality, THAT will be something, lol.

[+ purplekow]

Has anyone else noticed its always the same people who comment about this and its always the same tired argument for not using? We can always rely on purple cow to be the doomsayer of the group too "were all gonna die!!!!"

Not all of us just some of the ones who aren't careful. Chris i lived personally and professionally through one epidemic. I am not interested in living though another one. Watching people die, wasting away, for many years, most of them before you were born, makes me wary. You apparently have all the answers you need and i wish you and your clients good luck with that.

[Steven_Draker]

Has anyone else noticed its always the same people who comment about this and its always the same tired argument for not using? We can always rely on purple cow to be the doomsayer of the group too "were all gonna die!!!!"

 

I think that opening a thread and having a discussion about PrEP and prevention is a good thing.

 

Shunning the discussion/problem wouldn't be beneficial.

[jimboivyo]

I think that opening a thread and having a discussion about PrEP and prevention is a good thing.

 

Shunning the discussion/problem wouldn't be beneficial.[/color]

 

 

yup. exactly