[Question #8790] Questions on prep
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39 months ago
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Hello doctors,I am straight male Delhi ,lndia 36 years old ..........i started prep( truvada : tenevir em generic) myself to reduce my hiv anxiety on 12th april with double dose and then daily ........before starting prep tested negative for hiv ( previous exposure 90 days back)and hbsag ( hepB) negative and blood test for kidney, liver all normal .......test on 27th March 22
Exposure
1. 13th April only handjob and massage after taking prep double dose on 12th april
2. on 20th april have condom protected vaginal sex with high end sex worker that is after 8 days of starting prep ( after 9 pills)................
3. 23rd april i have condom protected blowjob ....no vaginal sex ......only blowjob.......i am still taking prep ( truvada) daily............. As i concerned about sideeffects i tested for liver and kidney on 24th April .............there is increased in alt levels 46 to 66 and ast 29 to 43. Also i have burning pain in stomach but now its less .........little loose stools, for last 4-5 days .......everything is fine other than this. Also in between i am eating fatty food outside daily .....alcohol too..... I also talked to doctor on 26th April ( infectious diseases specialist) she said truvada don't effect liver ......and give me evion 400 mg vitamin E for liver ............for 15days
My questions
1. Should i stop prep due to sideeffects .......or they are common sideeffect .......will they go away sir I want to take it because it help a lot in my anxiety( no hiv fear) and I enjoy sex but I fear side-effects.
2. Does prep ( truvada ) affect liver ....my creatinine .86 and egfr are 114 ....after 15 days of prep
3. I am on daily prep and my protected vaginal sex exposure is after 8 days of starting prep if I want to stop prep ......do I take it for 7 sex free days ( British guidelines) after exposure or 2 sex free day or 28 sex free days my doctor told me 28 days.....lot of confusion in this for heterosexual man.
4. Better option truvada or descovy. Side-effects
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Edward W. Hook M.D.
39 months ago
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Welcome to our phones. Thanks for your questions. I’ll be glad to comment. Congratulations on your approach to HIV prevention. Prep is safe and highly effective. Having started it I would urge you to continue unlessyou suffer major side effects. Straight on to your questions:
1. The changes you describe would not cause concern for me. I believe you have done the right thing and discussing this with your doctor and I would continue to do so.
2. Prep is generally well tolerated and safe. As I mentioned above, I would discuss this with your doctor. Your creatinine is normal and not a concern.
3. When HIV is acquired, it is acquired at the time of sexual activity. Data on stopping prep are variable as you have found out however, in general, stopping prep after 7 sex free days should not put you at any risk for acquisition of HIV from past exposures.
4. No meaningful difference. both are highly effective.
EWH
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39 months ago
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Hello Doctor,
Thanks for your answers
I want to ask few things more for knowledge. I am taking prep ( truvada) daily for last 42 days .....I have tested again for kidney , liver and lipid profile .......everything is fine hdl decrease little........alt still little above normal range 61( normal is 50) previously it is 66 so improvement in liver after 25 days .....creatinine is .81 and egfr is 116 .....so I assume kidney is fine. My questions.
1. Do truvada ( daily prep) protects from oral hiv exposure like nipple sucking ( breast milk) or little blood during kissing sex worker if my gums are swollen .I think they are virtually zero risk but prep make them truly zero risk ......am I right .....or prep only works in vaginal sex?
2. As you have told me earlier we can stop prep after 7 sex free days do this statement valid for all sexual activities ........oral sex, vaginal sex ....kissing etc. Just want to confirm. I am planning to use condom always for vaginal sex.
3. I am comfortable with truvada .........and planning to test every three months for hiv , kidney ,etc ....am I right in doing this or I can do after every six months ......I am 36 yrs healthy male.
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Edward W. Hook M.D.
39 months ago
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1. Prep is highly protective against all exposures to infectious HIV. HIV is not acquired and adults by sucking on an infected partners nipple or kissing even if the person who has been kissed has blood in their mouth for mouth sores.
2. Yes
3. At the present time follow-up of patients receiving prep is recommended to be carried out at three month intervals. Search screening should include the tests you described as well as testing for STI‘s as prep does not prevent acquisition of STI‘s such as gonorrhea, chlamydia, and Syphilis.
I hope this information is helpful. Take care. EWH
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38 months ago
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Thanks doctor for your answers.
One last question.
1. I am with massage therapist .....sucked her nipple for 2 sec ....no taste of milk ....but she is breast feeding her 7 month old child .......I know that few drops of milk in my mouth not trannsmit hiv .....even if she is hiv +...........just in case breast milk is risk then also as I am on truvada daily for last 50 days it will protect me completely..............am I correct ...just want to confirm.
Sorry to bother you ......and thanks again for your great services .....it help me a lot.
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Edward W. Hook M.D.
38 months ago
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Adults cannot acquire HIV from ingestion of breat milk from an HIV infected person. Thus, even if your masseuse had HIV and you swallowed her breast milk there would be no risk. In addition, your PrEP would be protective.
Hope this is helpful. Please don’t worry.
This completes this thread. EWH
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