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View Diary: What’s Up With Women and HIV-Prevention Method PrEP? (7 comments)

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  •  Tipped and Rec'd with a caveat (4+ / 0-)

    I certainly can see why the female partner of a male with HIV who wants to conceive a child would be willing to assume the risk of substituting PrEP for transmission blocking techniques that don't permit pregnancy. And there is every reason to support studies undertaken to determine the efficacy of PrEP for ALL populations. But the risks are real and they should not be minimized.

    As someone who's been on HIV medications for over two decades, I find it challenging to recommend to ANYONE who isn't HIV-infected that they take any of these medications. All HIV meds without exception pose some degree of risk and are subject to long-term side effects. Apart from the dangers inherent in them, many people who MUST take HIV medications find them singularly unpleasant to take in one way or another.

    Some of the more immediate side effects of HIV meds go away with time; others are less tractable and more prolonged. Beyond that however is the risk that despite using PrEP a person could nonetheless theoretically contract HIV himself or herself. Speaking from personal experience, having to live with HIV is really NOT desirable.

    There are many variables involved. It is widely known for example that HIV-infected individuals whose viral load is undetectable are at lower risk of infecting others, whether those others are on PrEP or not. But not everyone achieves equal degrees of success with HIV medication. Higher viral loads are associated with increased risk of infection. It does seem to me that someone who is taking HIV medications, even normally effective ones, where those meds aren't successfully controlling their viral loads to the undetectable range, are at greater risk of transmitting HIV to someone even if that other person is on PrEP for the simple and obvious reason that not all strains of HIV are equally susceptible of management with any particular drug regimen. So there is a non-negligible risk of developing a false and unwarranted sense of security with respect to contracting HIV. And there is also the concern that what would be transmitted would strains of HIV which are already drug-resistant to a greater or lesser extent.

    •  rAmen (2+ / 0-)
      Recommended by:
      historys mysteries, sfbob

      We poz folks need to emphasize this:

      As someone who's been on HIV medications for over two decades, I find it challenging to recommend to ANYONE who isn't HIV-infected that they take any of these medications. All HIV meds without exception pose some degree of risk and are subject to long-term side effects.
      This is particularly important when it comes to PrEP, since the primary drug involved is tenofovir, which has been shown to impair kidney function in some of those who take it.  It's a component of Truvada, which I take, and my doctor has to watch my kidney functions like a hawk.

      Don't get me wrong.  Today's drugs are a far cry from those that were available as recently as ten years ago.  The newer drugs are generally far better tolerated and less toxic.  But no drug is entirely without toxicity or side-effects.  Anyone considering using PrEP, either in conjunction with or as a substitute for, condoms or other forms of prevention needs to be aware of this issue to be able to make an informed decision.

      "Ça c'est une chanson que j'aurais vraiment aimé ne pas avoir écrite." -- Barbara

      by FogCityJohn on Wed Mar 06, 2013 at 04:53:47 PM PST

      [ Parent ]

      •  I can no longer take tenofovir (1+ / 0-)
        Recommended by:
        FogCityJohn

        For the same reasons you've described. There hasn't been any obvious damage but that's only because my doctor keeps close tabs on my blood chemistry. I simultaneously stopped Viread (tenofovir) and Ziagen about six months ago to prevent any serious kidney damage. We were getting to that point and I'm glad I'm no longer on either one. I was able to tolerate both for several years but there is a limit.

        Liver and kidney function impairment appear to be the major issues with most current HIV drugs. Once you experience that, your treatment options are quite limited.

        •  I hear ya. (1+ / 0-)
          Recommended by:
          sfbob

          To protect my kidneys, I no longer take any kind of NSAIDs for any reason at all.  That means no Advil, no aspirin, no Naproxin.  So when I injure a muscle at the gym or get a headache, I just put up with the pain, since NSAIDs can harm the kidneys.

          I've also given up alcohol to protect my liver.  The reason for that isn't really HIV drugs, but rather the chronic hepatitis B infection I've had since I was an infant.  Still, my doctor doesn't want my liver to have to deal with processing a bunch of ARVs plus alcohol.

          So no more pain relief or happy hour fun for me.  And those are just two of the more minor adjustments I've had to make because of HIV.  Again, despite all the improvements in ARVs over the past several years, these are still very serious medications, and they should be avoided if at all possible.

          "Ça c'est une chanson que j'aurais vraiment aimé ne pas avoir écrite." -- Barbara

          by FogCityJohn on Thu Mar 07, 2013 at 09:56:42 AM PST

          [ Parent ]

          •  I'll keep on using NSAID's until someone tells me (1+ / 0-)
            Recommended by:
            FogCityJohn

            that I can't. It's really pretty simple. I may be in better shape than you in regard to kidney function as any consequences I've had are, at this point showing up in blood work but not in any sort of experienced malfunction.

            Lucky me; despite two bouts of hepatitis within 9 months when I was in my 20's I never contracted Hep B, was thus able to participate in the vaccine trial, and consequently able to pinpoint when I was infected with HIV.

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