[Question #12969] Prep On Demand

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3 months ago
Hi doctors, 
I took 2 Truvada pills as part of the on demand 2-1-1 dose but I then had sex earlier than the prescribed 2 hours minimum. I had sex about 45 -60mins after the first dose. 
Can I be confident that my 2-1-1 dosage will still be equally effective if I take the remaining 24 and 48 hour doses correctly?
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H. Hunter Handsfield, MD
3 months ago
Welcome back. However, this question would best be answered by the doctor or clinic where your PrEP has been prescribed.

Such minor deviations in recommended timing are unlikely to have any effect on the effectiveness of PrEP on demand, but your own doctor/clinic might have a different understanding. They probably have just as much experience and knowledge about PEP and PrEP as we do, maybe more. In addition, PrEP on demand is not advised if potentially risky exposures are frequent. The available studies show PrEP on demand to be 85-95% effective, compared with 99% effectiveness for continuous PrEP. Based on your previous forum questions, I wonder if you're having new sex partners or other sorts of exposures that risk HIV that you should be on continuous instead of PrEP on demand. Also discuss this with your doctor or clinic.

Best wishes and good luck.

HHH, MD
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3 months ago
Good day. I have been on continuous Prep for a long time. Then stopped since I did not anticipate any risky sexual exposures. 

However, I met someone new and decided to take on demand prep. I tested the morning after exposure. We both tested negative on the home test kit. 

I just continued with the 24 and 48 hour doses of prep on demand though. It would be safe to say I never needed prep anyways right? Since we both tested negative.

I ask because some few online sources say negative antibody tests does not necessarily mean risk free if someone is in the window period. However, guidelines from local clinicians and doctors are that if these tests are negative, they don’t even prescribe PEP.
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H. Hunter Handsfield, MD
3 months ago
"It would be safe to say I never needed prep anyways right? Since we both tested negative." Yes, I agree. As indicated by your last sentence, it is true that some anxious persons worry that someone could be in the window period, i.e. very recently acquired infection not yet detectable by the standard blood tests. However, if the blood test is negative, then even if someone is recently infected, they usually do not yet have high enough virus levels in blood and sexual fluids to transmit the infection. The exceptions are believed to be extremely rare and I am in agreement with the "local clinicians and doctors" who would not prescribe PEP.---