Prep

[deleted10023221]

Does anyone know about PrEP? I just asked my doctor about getting on it. She said it was expensive and I go back in a few weeks to get a script.

 

[deleted1074483]

what did you want to know about PrEP??

 

[deleted10023221]

Side effects, cost, etc. I'd like to get as much info as I can from someone who has taken this. I know there's info on the Internet, but these are not from actual PrEP users. Is it worth the cost? Will the cost come down after the patent expires? Thanks!

 

[dreambridger]

I have some specific questions about this topic

Does anyone have a preference between Discovy and Truvada, or are they the same?

Has anyone noticed side effects?

@oralsexlover my ex was able to get his PrEP covered with his insurance. Maybe see if your insurance qualifies you.

 

[Jlatinochub]

Discovy is not effective on women in case there are bi men here.

 

[deleted10023221]

I have some specific questions about this topic

Does anyone have a preference between Discovy and Truvada, or are they the same?

Has anyone noticed side effects?

@oralsexlover my ex was able to get his PrEP covered with his insurance. Maybe see if your insurance qualifies you.

Thanks, I'll check.

 

[winesthel945]

So, there's some incorrect information above.

First: "Descovy doesn't work on women." is not true. The first clinical trials focused on gay men, therefore there wasn't enough research for the FDA to officially approve it for CIS females. That doesn't mean it "doesn't work." Doctors are prescribing it for women who are in need of PrEP, it's just technically termed "off label" and there are a bunch of studies underway that include women and they're showing the same efficacy as Truvada for all groups in the testing.

Descovy is a newer version (and most importantly -- newly PATENTED version) of mostly the same ingredients as Truvada. It's more effective at a slightly lower dose than Truvada. Literally, the pills are smaller. As with Truvada, there are some possible side effects with Descovy. They're statistically rare but not unheard of. They're much less consequential than the side effects of the drugs you will need to take if you become HIV+.

The patent, and the associated higher prices with a new non-generic drug, are one of the reasons for introducing Descovy. That and, of course, the general advancement in the technology. But now that Truvada can be made "generic," it's coming way down in price and becoming more frequently prescribed. That's not to say Descovy is only about the money, but it's not unimportant to understand if you're trying to understand why it's new and why it's more expensive, and thus why some insurance providers don't cover it yet.

As with all PrEP regimens, doctors will typically require you to get blood work every 3 months in order to renew your prescription. This is to check for HIV status, but also to check for other side effects, particularly liver issues. It's also usually coupled with other STI screenings as secondary infections can increase susceptibility for contracting HIV, as well as people who are having regular unprotected sex are at much higher risk of STIs.

On side effects:

Liver -- Some people -- ~2% of people who take either Truvada or Descovy -- experience a slight elevation in certain liver-related blood tests. This is usually well within safe ranges, but if you have other liver problems it's something to watch out for. Liver function is an easy blood test and if you're taking any other meds, you may already be getting regular liver function bloodwork. Descovy shows a slightly lower incidence of this side effect than Truvada, but the clinical trial numbers show these are rare and small.

Kidney -- about the same percentage (~2%) of people on either drug, have experienced some increased kidney-related enzyme numbers. Again, usually not a problem if your kidneys are otherwise functioning ok. Descovy has slightly lower impact frequency (like 1.8% versus 2.3%). But it's still very rare.

Bone density -- About 4% of Truvada users, and 1% of Descovy users in *one* study were reported as having negative effects on their bone density. More research is being done into this but it's not considered dangerous, again unless you're already having some issues with bone density loss.

Cholesterol -- Several studies have shown that both drugs may have minor impact on blood cholesterol and triglyceride levels. Minor fluctuations; one study showed Descovy increasing triglycerides by 9 points... not a huge increase, but again it's unclear as to whether it was solely the Descovy and more research is underway. Again, mostly only an issue if you're already having cholesterol issues, and in a few instances, Truvada actually shows tiny reductions (~1-2 points) in cholesterol numbers, but overall it's not a huge issue.

Transient side effects -- Many people experience some transient side effects like nausea, stomach cramps, headache, diarrhea, etc. Some of these are most common when you take these (or really ANY medication) on an empty stomach. Take it with some food and you'll usually be fine. In most cases these side effects are easily mitigated or go away after a few days/weeks of taking the medication.

This article has a lot of the ORIGINAL clinical trial info comparing Truvada and Descovy; it's not comprehensive and doesn't include all the newest data. You'll need to do your own research to find that. Side Effects of Descovy (Emtricitabine and Tenofovir Alafenamide Tablets), Warnings, Uses

Insurance and cost -- Now that Truvada can be made generically, the cost is coming way down. This is making it easier for public health authorities to make it available. I know that in San Francisco, you can get it for free at the City Clinic.

Most insurance companies will cover Truvada now that it's a generic, though you may need to go through a special approval process. There might be higher co-pays. Gilead, the maker of Truvada and Descovy, have a "co-pay card" that will pay your co-pay, or may cover your entire cost in some cases: Gilead Advancing Access® Medication Co-pay Coupon Card

Finally, Descovy and Truvada were recently approved in the US for a regimen called "2-1-1". Basically, if you are able to schedule sexual adventures in advance, you can go on PrEP for a short period of time surrounding your potential exposure. You take double the dose at least 24 hours (2 pills) in advance of the possible exposure event, then take one dose (1 pill) the day of the possible exposure event, and then one dose the day following. This can be extended if you've got a busy weekend of fucking -- 2 doses at least 24 hours prior, then one dose a day until at least the day following your last exposure. See On-Demand PrEP | PrEP | HIV Basics | HIV/AIDS | CDC for more information. The benefit of the 2-1-1 approach is that you don't need to remember to take it every day over the long-term, and if you do have any side effects they are confined to a specific period so that, for example, the liver, kidney, or bone density issues are unlikely to be factors for the long term.

Personally, I was on Truvada for many years. My only issues were occasional nausea and stomach cramps if I took it on an empty stomach -- though I take other meds in the morning too and they hit my stomach like a rock if I don't have a little food... even just some toast or a pastry. I tried to switch to Descovy, but my insurance company initially denied the request saying they would only cover Truvada. My copay for Truvada was at their "specialty drug" rate of $20/month, which I was able to cover completely with the Gilead co-pay card so that was nice. I changed insurance providers with a new job and the new provider covers Descovy, though they did need to go through a review process including my doctor telling them he had reasons for wanting me to switch. The new co-pay with the new insurance is also $20/mo, but the pharmacy still had my Gilead card on file and it automatically covered the Descovy co-pay too.

Good luck!

 

[winesthel945]

Discovy is not effective on women in case there are bi men here.

That is not correct. The first clinical trials focused on gay men, therefore there wasn't enough research for the FDA to officially approve it for CIS females. That doesn't mean it "doesn't work." Indeed, doctors ARE prescribing it for women who are in need of PrEP, it's just technically termed "off label" and there are a bunch of studies underway that include women and they're showing the same efficacy as Truvada for all groups in the testing.

This is like the initial studies of the mRNA vaccines for COVID were only done on adults, so they weren't yet approved for use in children. But now that the studies including children are coming in, they're starting to expand the use authorization accordingly.

 

[deleted10023221]

So, there's some incorrect information above.

First: "Descovy doesn't work on women." is not true. The first clinical trials focused on gay men, therefore there wasn't enough research for the FDA to officially approve it for CIS females. That doesn't mean it "doesn't work." Doctors are prescribing it for women who are in need of PrEP, it's just technically termed "off label" and there are a bunch of studies underway that include women and they're showing the same efficacy as Truvada for all groups in the testing.

Descovy is a newer version (and most importantly -- newly PATENTED version) of mostly the same ingredients as Truvada. It's more effective at a slightly lower dose than Truvada. Literally, the pills are smaller. As with Truvada, there are some possible side effects with Descovy. They're statistically rare but not unheard of. They're much less consequential than the side effects of the drugs you will need to take if you become HIV+.

The patent, and the associated higher prices with a new non-generic drug, are one of the reasons for introducing Descovy. That and, of course, the general advancement in the technology. But now that Truvada can be made "generic," it's coming way down in price and becoming more frequently prescribed. That's not to say Descovy is only about the money, but it's not unimportant to understand if you're trying to understand why it's new and why it's more expensive, and thus why some insurance providers don't cover it yet.

As with all PrEP regimens, doctors will typically require you to get blood work every 3 months in order to renew your prescription. This is to check for HIV status, but also to check for other side effects, particularly liver issues. It's also usually coupled with other STI screenings as secondary infections can increase susceptibility for contracting HIV, as well as people who are having regular unprotected sex are at much higher risk of STIs.

On side effects:

Liver -- Some people -- ~2% of people who take either Truvada or Descovy -- experience a slight elevation in certain liver-related blood tests. This is usually well within safe ranges, but if you have other liver problems it's something to watch out for. Liver function is an easy blood test and if you're taking any other meds, you may already be getting regular liver function bloodwork. Descovy shows a slightly lower incidence of this side effect than Truvada, but the clinical trial numbers show these are rare and small.

Kidney -- about the same percentage (~2%) of people on either drug, have experienced some increased kidney-related enzyme numbers. Again, usually not a problem if your kidneys are otherwise functioning ok. Descovy has slightly lower impact frequency (like 1.8% versus 2.3%). But it's still very rare.

Bone density -- About 4% of Truvada users, and 1% of Descovy users in *one* study were reported as having negative effects on their bone density. More research is being done into this but it's not considered dangerous, again unless you're already having some issues with bone density loss.

Cholesterol -- Several studies have shown that both drugs may have minor impact on blood cholesterol and triglyceride levels. Minor fluctuations; one study showed Descovy increasing triglycerides by 9 points... not a huge increase, but again it's unclear as to whether it was solely the Descovy and more research is underway. Again, mostly only an issue if you're already having cholesterol issues, and in a few instances, Truvada actually shows tiny reductions (~1-2 points) in cholesterol numbers, but overall it's not a huge issue.

Transient side effects -- Many people experience some transient side effects like nausea, stomach cramps, headache, diarrhea, etc. Some of these are most common when you take these (or really ANY medication) on an empty stomach. Take it with some food and you'll usually be fine. In most cases these side effects are easily mitigated or go away after a few days/weeks of taking the medication.

This article has a lot of the ORIGINAL clinical trial info comparing Truvada and Descovy; it's not comprehensive and doesn't include all the newest data. You'll need to do your own research to find that. Side Effects of Descovy (Emtricitabine and Tenofovir Alafenamide Tablets), Warnings, Uses

Insurance and cost -- Now that Truvada can be made generically, the cost is coming way down. This is making it easier for public health authorities to make it available. I know that in San Francisco, you can get it for free at the City Clinic.

Most insurance companies will cover Truvada now that it's a generic, though you may need to go through a special approval process. There might be higher co-pays. Gilead, the maker of Truvada and Descovy, have a "co-pay card" that will pay your co-pay, or may cover your entire cost in some cases: Gilead Advancing Access® Medication Co-pay Coupon Card

Finally, Descovy and Truvada were recently approved in the US for a regimen called "2-1-1". Basically, if you are able to schedule sexual adventures in advance, you can go on PrEP for a short period of time surrounding your potential exposure. You take double the dose at least 24 hours (2 pills) in advance of the possible exposure event, then take one dose (1 pill) the day of the possible exposure event, and then one dose the day following. This can be extended if you've got a busy weekend of fucking -- 2 doses at least 24 hours prior, then one dose a day until at least the day following your last exposure. See On-Demand PrEP | PrEP | HIV Basics | HIV/AIDS | CDC for more information. The benefit of the 2-1-1 approach is that you don't need to remember to take it every day over the long-term, and if you do have any side effects they are confined to a specific period so that, for example, the liver, kidney, or bone density issues are unlikely to be factors for the long term.

Personally, I was on Truvada for many years. My only issues were occasional nausea and stomach cramps if I took it on an empty stomach -- though I take other meds in the morning too and they hit my stomach like a rock if I don't have a little food... even just some toast or a pastry. I tried to switch to Descovy, but my insurance company initially denied the request saying they would only cover Truvada. My copay for Truvada was at their "specialty drug" rate of $20/month, which I was able to cover completely with the Gilead co-pay card so that was nice. I changed insurance providers with a new job and the new provider covers Descovy, though they did need to go through a review process including my doctor telling them he had reasons for wanting me to switch. The new co-pay with the new insurance is also $20/mo, but the pharmacy still had my Gilead card on file and it automatically covered the Descovy co-pay too.

Good luck!

TY for the details!

 

[dfw051980]

I think the posters above summed up info nicely. Personally I’ve been on both didn’t have issues with either. You have to be monitored on 3 month check up on blood work so keep that in mind, mostly for kidney functionality on both drugs. My Insurance covered both so I was lucky (I’m changing insurance soon so who k owns what will happen then).

But let me say this, keep in mind how much sex you are actually having before you decide. If you engage in a lot of sex with multiple partners or you engage in unprotected sex I think it’s definitely something to consider but if not maybe really discuss it with your doctor first. In past years I was more sexually active so yah I appreciated having the extra protection. Very beginning of 2020 I decided to stop as I wasnt really having sex that often anymore, and even though prep isn’t dangerous Im also in the camp of not taking medication if I aren’t truly getting the benefits from it... meaning if your not having sex, why take it.

this year I’m def more open to having some fun so I’m back on it, but to summarize just think about how active your sex life is before using it.

 

[theplayerking]

I was on PrEP before I met my boyfriend. I really liked going to sex parties and hooking up a lot. My insurance covered everything and I had no side effects that I noticed. If you hook up a lot, it’s definitely worth it in my opinion.

 

[Aintnotelling]

Side effects, cost, etc. I'd like to get as much info as I can from someone who has taken this. I know there's info on the Internet, but these are not from actual PrEP users. Is it worth the cost? Will the cost come down after the patent expires? Thanks!

Side effects aren’t really noticeable besides when you stop taking for a few days imo. Cost can be expensive but head over to this site called heymistr and they will send you by mail an std testing for free and if you can get on the program they offer for free 30 day pills worth of prep.
Here’s the link!
PrEP - PRESCRIBED ONLINE, DELIVERED TO YOUR DOOR.

 

[LICNYCgay]

I take PrEP before going to a sex party. If you can plan your sexual encounters there’s no need to take it every day. You take 2 pills 2 to 24 hours before sex, then take one pill a day for the next 2 days. My doctor turned me onto this regimen and I researched it myself online, and studies show it’s as effective as taking it daily.

Further reading: For people having anal sex, PrEP 2-1-1 is effective at preventing HIV - San Francisco AIDS Foundation

 

[Sumdud13]

This sounds risky... It usually takes 2 weeks to build up enough of it in your system for protection. Not sure how taking it on a intermittent basis would allow for enough immunity

 

[winesthel945]

This sounds risky... It usually takes 2 weeks to build up enough of it in your system for protection. Not sure how taking it on a intermittent basis would allow for enough immunity

If you read that article, you'll see that a 2x dose 24 hours prior, with 1x dose the day of, and 1x dose every day until one say following, is sufficient to reach protective levels for anal sex. But for vaginal sex, that does require longer use as those tissues require more time to absorb the medicine.

In this case you're not taking it "intermittently," you're taking it in the immediate window surrounding exposure. If you're only having unprotected sex once a month or once every few months, then the 2-1-1 approach gives you effective coverage just during those windows. Studies going back as far as 2017 show it to be adequate.

If you're having sex on a regular basis, or don't think you'll have 24 hours notice of sexy time, then you need to be on a consistent regimen... and the research backs that up as well. But for infrequent, planned potential exposure, the 2-1-1 regimen is sufficient.

 

[deleted10023221]

I asked my doctor about Prep. I had to tell her I was bi but mostly with guys these days, so she had an HIV lab ordered for me. I am negative, thank god and she told me about the consequences of Prep. There are too many health risks involved with it, really. She told me to make sure my partner is HIV- or use a rubber. Use a rubber for giving head? Not me. I'm not out, so it was hard for me to tell her I was bi. Thanks for all your info!

 

[winesthel945]

I asked my doctor about Prep. I had to tell her I was bi but mostly with guys these days, so she had an HIV lab ordered for me. I am negative, thank god and she told me about the consequences of Prep. There are too many health risks involved with it, really. She told me to make sure my partner is HIV- or use a rubber. Use a rubber for giving head? Not me. I'm not out, so it was hard for me to tell her I was bi. Thanks for all your info!

Your doctor is an idiot, probably homophobic, certainly ill-informed about PrEP, and giving out bad advice. You need a new doctor.

First, the "health risks" from taking PrEP are minuscule for most people and easily monitored with bloodwork done at the same time you get your HIV screen every 3 months.

Second, "Make sure your partner is HIV-"? That is absolutely irresponsible and asinine advice from someone who clearly doesn't know what the fuck she's talking about. Does that doctor have pills to make you psychic? She's stupid. You have to protect yourself and PrEP is >99% effective regardless of whether you can accurately sense the "aura" of your sex partner... or however this dumbass suggests you "make sure." Good grief! That's seriously Reagan-era homophobic advice.

Third, the instances of oral transmission of HIV are vanishingly rare, so that's stupid anyway. Condoms for oral sex can help with other STIs, but that's not how you'd likely contract. My guess is that your doctor is some kind of religious conservative nutcase who is generally anti-sex, probably anti-LGBTQ, and definitely doesn't know what the fuck she's talking about.

You need to find a physician who can treat you as you are, as you want to be, not as she thinks you should be behaving. You're in Tampa? There are a zillion LGBTQ-friendly physicians in that region. (I know this, I have a bunch of gay friends in the Tampa/St.Pete region, one of whom is a dermatologist.) Google "LGBT friendly doctors Tampa" and there's a ton of resources, Yelp lists, and doctors offices promoting their gay-community outreach. One of the first hits is even Diversity Health Center of Tampa Bay which WILL GIVE YOU PREP THEMSELVES so you can bypass moron physicians.

Seriously, get yourself a new doctor -- she's irresponsible and ill-informed. There's no telling what else she'd giving you bad advice about. Her bad information is placing you at risk.

 

[deleted10023221]

Your doctor is an idiot, probably homophobic, certainly ill-informed about PrEP, and giving out bad advice. You need a new doctor.

First, the "health risks" from taking PrEP are minuscule for most people and easily monitored with bloodwork done at the same time you get your HIV screen every 3 months.

Second, "Make sure your partner is HIV-"? That is absolutely irresponsible and asinine advice from someone who clearly doesn't know what the fuck she's talking about. Does that doctor have pills to make you psychic? She's stupid. You have to protect yourself and PrEP is >99% effective regardless of whether you can accurately sense the "aura" of your sex partner... or however this dumbass suggests you "make sure." Good grief! That's seriously Reagan-era homophobic advice.

Third, the instances of oral transmission of HIV are vanishingly rare, so that's stupid anyway. Condoms for oral sex can help with other STIs, but that's not how you'd likely contract. My guess is that your doctor is some kind of religious conservative nutcase who is generally anti-sex, probably anti-LGBTQ, and definitely doesn't know what the fuck she's talking about.

You need to find a physician who can treat you as you are, as you want to be, not as she thinks you should be behaving. You're in Tampa? There are a zillion LGBTQ-friendly physicians in that region. (I know this, I have a bunch of gay friends in the Tampa/St.Pete region, one of whom is a dermatologist.) Google "LGBT friendly doctors Tampa" and there's a ton of resources, Yelp lists, and doctors offices promoting their gay-community outreach. One of the first hits is even Diversity Health Center of Tampa Bay which WILL GIVE YOU PREP THEMSELVES so you can bypass moron physicians.

Seriously, get yourself a new doctor -- she's irresponsible and ill-informed. There's no telling what else she'd giving you bad advice about. Her bad information is placing you at risk.

Homophobic? Oh, without a doubt. I live in a homophobic area closer to St. Pete. Yeah, she's only my PCP. It's hard enough to meet guys, then to make sure they are HIV- makes it that much harder. That's why I turned to this site for answers. I get good honest advice here. Thank you, I think you're right. I will check out that Diversity Health Center.

 

[malakos]

... then to make sure they are HIV- makes it that much harder.

To be clear, such knowledge is impossible in most cases. Any judgment about someone being neg relies heavily on trust. What you have to trust essentially is that the person has been tested recently, received a negative result, and has not been having sex for the past few months (to account for the recent window of time that the test is not sufficiently sensitive to). If this is someone you are highly familiar with, then maybe you know him well enough to know what sort of lifestyle he leads, and would be warranted in taking his word about his results, and that he hasn't been doing any messing around in the more recent period of time. But in the vast majority of MSM hookups, one does not know the other guy well enough for such trust to be warranted.

Skillful and attentive condom use will reduce your risk of contracting HIV greatly. But do think over this "make sure they're HIV-" business. Buying into that kind of thinking often results in very poor judgments about what is necessary to stay safe. This is especially relevant if you're considering engaging in anal sex.

 

[Infernal]

Whatever protocol you decide to take, just remember that HIV isn't the only thing out there and PreP will NOT protect you from other STD/STI's. If you have any doubts about your partner or partners, then consider using additional protection.