6 ms·

In terms of protecting oneself, what are the actual steps? (E.g. if you're HIV- but are participating in activities either directly with someone who is HIV+ or

In terms of protecting oneself, what are the actual steps? (E.g. if you're HIV- but are participating in activities either directly with someone who is HIV+ or whose partner is HIV+.) Do you schedule a doctor appointment and ask for something specific? And is there anything else to do, such as something over-the-counter? There's a dizzying array of terms to learn in this space. PrEP is apparently different from PEP, which I think is also unrelated to what this article is talking about. It'd be nice if someone put together a 2024 guide for what the latest preventative / protection mechanisms are.

toomuchtodo 2y ago
Assuming you do not currently have a viral load of HIV, you can meet with your provider, indicate that you are at risk, and request a prescription for PrEP [1] (Planned Parenthood can assist with sourcing if you don't have a PCP or other stable medical providers). Longer term, it is likely there will be a shift to a twice yearly injectable (Gilead’s Lenacapavir) [2]. State of the art is an undetectable viral load due to antiviral treatment means you cannot transmit to others [3] [4] [5]. Not medical advice, educational purposes only. Seek a medical professional's guidance for your personal circumstances. [1] https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medi... [2] https://news.ycombinator.com/item?id=40742163 https://news.ycombinator.com/item?id=40742163 [3] https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/viral-suppression https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treat... [4] https://www.niaid.nih.gov/diseases-conditions/treatment-prevention https://www.niaid.nih.gov/diseases-conditions/treatment-prev... [5] https://www.hiv.gov/blog/science-validates-undetectable-untransmittable-hiv-prevention-message https://www.hiv.gov/blog/science-validates-undetectable-untr...
- ClarityJones 2y ago
  From [5] https://www.hiv.gov/blog/science-validates-undetectable-untransmittable-hiv-prevention-message https://www.hiv.gov/blog/science-validates-undetectable-untr...: > Even when viral load is undetectable, ... may have detectable HIV genetic material in ... semen, but there is no scientific evidence that such material is associated with HIV transmission. What? Isn't that the primary transmission vector?
  - toomuchtodo 2y ago
    From that same link you cite: > Findings from the breakthrough NIH-funded HPTN 052 clinical trial, a decade-long study involving more than 1,600 heterosexual couples, offered clear-cut evidence that ART that consistently suppresses HIV also prevents sexual transmission of the virus. In 2011, the HPTN 052 investigators reported that starting ART when the immune system is relatively healthy, as opposed to delaying therapy until the immune system has been weakened by the virus, dramatically reduces the risk of sexually transmitting HIV. The protective effect of starting ART early was sustained over four additional years of follow-up. Importantly, when viral loads were measured, no HIV transmissions were observed when ART consistently, durably suppressed the virus in the partner living with HIV. Wild speculation is that the genetic material you mention is inactivated and therefore unable to transmit the virus, but is still detectable. I am just an internet rando surfing the knowledge graph, but the science appears sound. https://www.nih.gov/news-events/news-releases/hiv-control-through-treatment-durably-prevents-heterosexual-transmission-virus https://www.nih.gov/news-events/news-releases/hiv-control-th... https://web.archive.org/web/20150106032855/http://www.niaid.nih.gov/news/newsreleases/Archive/2011/Pages/HPTN052Breakthrough.aspx https://web.archive.org/web/20150106032855/http://www.niaid.... https://www.clinicaltrials.gov/study/NCT00074581 https://www.clinicaltrials.gov/study/NCT00074581
    - pstrateman 2y ago
      >1,600 heterosexual couples Is there a similar study of gay men who are not in a monogamous relationship? Studying the group with the lowest transmission rate who could still transmit seems kind of dishonest.
      - foldr 2y ago
        It's not 'dishonest'. It's important data for parts of the world where heterosexual transmission of the virus is common. And yes, there is a similar study: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30418-0/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
  - deleted 2y ago
    [deleted]
- chimeracoder 2y ago
  > Longer term, it is likely there will be a shift to a twice yearly injectable (Gilead’s Lenacapavir) That's debatable. Injectable PrEP has been around for years already (Lencapavir is not the first, just the most recent). Lencapavir has also not yet been tested on all at-risk groups, so unlike other forms of PrEP, it's not a universal solution because it cannot be prescribed to all candidates. Given the price, which is quite high even with the programs Gilead has said that it will issue to reduce the cost, it remains to be seen how widely-used Lencapavir becomes outside of specific markets.
  - borski 2y ago
    I’m confused. The parent comment said “longer term,” and you went on to discuss how it is not going to be used in the short term, due to the need for more testing and cost. Cost comes down over time, and more testing occurs over time, somewhat by definition. So… what specifically is debatable about the longer term?
    - chimeracoder 2y ago
      > Cost comes down over time, and more testing occurs over time, somewhat by definition. Truvada has been around for over twenty years, and generic for 4-5 years. It still costs $2000/month list price. More testing doesn't just magically happen either. Gilead has chosen for years not to pursue testing, let alone approval, for Descovy in various groups excluded from the original clinical trials. They've decided it's not profitable enough for them. The same could very easily happen with lencapavir, and in fact there's good reason to suspect it will.
      - borski 2y ago
        Why is it so expensive? And is it covered by insurance? If so, then I'm not sure the list price matters all that much from a 'to most people' perspective, even if there is a moral argument to be had here (in which we'd probably agree). I'm not entirely sure what the argument is, though - is it just the cynical argument of "well, these companies don't care about solving problems, just profit, so they're never going to do anything with it"? If so, then at least I understand your argument, even if I don't necessarily agree. But I tend to be an optimist.
nerdjon 2y ago
What I have noticed is that in most situations saying "PrEP" is enough. For my doctor that meant discussing Truvada, Descovy, and what is just kinda dubbed "Injectable Prep". This aligns with most apps also just saying "on prep" with no distinguishing between what prep. I would imagine that if/when this comes to market it would likely similarly fall under "Prep" for the general community and then you discuss the specifics with your doctor. Edit: There is also Doxypep (I just say Doxy), which while related to STD's is not related to HIV.
- felixg3 2y ago
  There are people announcing their PrEP status on dating apps so they can raw dog with strangers? Have people forgotten that there are plenty of STD besides HIV? I think this is highly problematic and lifestyle PrEP seems to be counterproductive as a public health measure. But I am open to arguments that I’m wrong. It’s possible that I am biased as a monogamous heterosexual who has grown up in a culture where sex without condom, especially outside committed relationships, is generally frowned upon and 1980-1990s HIV scares are still in the consciousness of people.
  - iknowstuff 2y ago
    Nobody’s giving or getting head with a condom. People who stay on top of preventative measures tend to not bother with condoms since PrEP became prevalent, because the rest of them you can get with or without a condom due to oral. Preventative: 1. Gardasil 9 (vaccine against 9 strains of HPV, prevents genital warts and cancers caused by HPV) 2. Monkeypox vaccine 3. Meningitis ACYW vax 4. Meningitis B vax (35% effective against gonorrhea) 5. doxyPEP (two pills of doxycycline taken after sex, 90% effective against syphilis, 80% chlamydia, 50% gonorrhea) 6. PrEP (prevents HIV infections) 7. and the usual suite of vaccines against the rest like hepatitis A/B, mumps etc You’ll notice all of these give you far more protection than a condom would. Again, especially since oral is a thing. Treatment of the bacterial ones (which transmit through oral too): 1. syphilis - butt shot of penicillin 2. chlamydia - 1/2 pills of an antibiotic 3. gonorrhea - a week of doxycycline pills or one butt shot of ceftriaxone Remaining unpreventable/untreatable one is HSV. Half of the population has it. Condoms dont prevent it either. Hepatitis requires blood contact and as such is not necessarily considered an STI, but hepatitis c is curable these days thanks to DAAs taken over the course of 8-12 weeks, and a/b variants have vaccines.
preventionexprt 2y ago
[flagged]
- nerdjon 2y ago
  That assumes that everyone you are engaging with knows their status. If someone knows they are HIV+ and are undetectable than you are more informed about the risk than you are in many other situations. Also, if your partner is positive are you really not going to want to be with someone just for that reason? Really need to get past the stigma around this and focus on education instead. Edit: You changed your comment to no longer mention just not engaging with people who are HIV+...
  - deleted 2y ago
    [deleted]
  - Vecr 2y ago
    Yeah, or just not "engage" with anyone. Manage risk, assume unknown or not completely trustworthy = positive.
  - hyperliner 2y ago
    [dead]
- sillysaurusx 2y ago
  One doesn’t always know. And besides, if in modern times the risk is essentially zero, then it’s worth considering.
4fterd4rk 2y ago
PrEP - An HIV negative person taking Truvada or Descovy once a day to prevent HIV infection. PEP - An HIV negative person taking a course of antiretrovirals within 72 hours after exposure to HIV to prevent HIV infection. This article is referring to injectable PrEP. This is already available via an injection every two months and is typically used in populations that can't be expected to take a pill every day (drug addicts, etc.). The article is referring to a new form of injectable PrEP that extends this to once every six months.
- chimeracoder 2y ago
  > This is already available via an injection every two months and is typically used in populations that can't be expected to take a pill every day (drug addicts, etc.). That is a pretty bold parenthetical statement. Not only is it not true that "drug addicts" can't be expected to take a pill every day, but neither cabotegravir nor lenacapavir are tested or approved for HIV acquired through non-sexual means, which makes them a poor choice for PrEP for "drug addicts" compared to oral forms, which are effective against all forms of HIV transmission. Source: former counselor and educator for HIV and substance use
  - fragmede 2y ago
    > Not only is it not true that "drug addicts" can't be expected to take a pill every day, The general population can't be expected to take a pill every day, what would make anyone believe people with SUD are able to? Source: person who's expected to take a pill every day, and knows other people who are supposed to taste a pill every day.
    - chimeracoder 2y ago
      > The general population can't be expected to take a pill every day, what would make anyone believe people with SUD are able to? The general population does take PrEP regularly enough to be protected. You seem think that people with substance use disorders are excluded from that, and that belief is grounded in stereotype and bias, not science. Source: clinical data and professional experience
masspro 2y ago
PEP means "post-exposure prophylaxis"; PrEP means "pre-exposure prophylaxis". You take PrEP regularly (if you know you're at risk due to sexual habits etc whatever), but only take PEP in response to a specific possible-exposure event (and not already on PrEP). You want pre-exposure instead of post-exposure because post-exposure is very hard on your body and makes you feel sick.
- dyauspitr 2y ago
  Why is post exposure so hard on the body. Isn’t it still just a 2 drug cocktail (truvada+another one)?
Eumenes 2y ago
Don't have sex with strangers you don't trust.
barfingclouds 2y ago
Clinics are pretty good. But in general, if you’re a woman in a first world nation your odds of getting it are really low, unless you do significant amounts of anal sex with bisexual men or inject drugs. Same thing with men. Straight men aren’t at much risk. Bi and gay men are at high risk. If you have a hiv+ partner, prep is good enough to keep you safe. Just take it always as prescribed. Pep in for when you may have been exposed, and you need to get it as soon as possible. It’s like a morning after pill. Within 72 hours of exposure but sooner is better. Then for anyone who does unprotected casual sex, there’s doxypep which reduces likelihood of bacterial stds by a lot, so gonorrhea, chlamydia, and syphilis. If you want a person to explain this to you in real life, there’s different clinics in every American city that would love to take the time to teach you about all of this. Part of their funding is to educate

toomuchtodo 2y ago

Assuming you do not currently have a viral load of HIV, you can meet with your provider, indicate that you are at risk, and request a prescription for PrEP [1] (Planned Parenthood can assist with sourcing if you don't have a PCP or other stable medical providers). Longer term, it is likely there will be a shift to a twice yearly injectable (Gilead’s Lenacapavir) [2]. State of the art is an undetectable viral load due to antiviral treatment means you cannot transmit to others [3] [4] [5]. Not medical advice, educational purposes only. Seek a medical professional's guidance for your personal circumstances. [1] https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medi... [2] https://news.ycombinator.com/item?id=40742163 https://news.ycombinator.com/item?id=40742163 [3] https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treatment/viral-suppression https://www.hiv.gov/hiv-basics/staying-in-hiv-care/hiv-treat... [4] https://www.niaid.nih.gov/diseases-conditions/treatment-prevention https://www.niaid.nih.gov/diseases-conditions/treatment-prev... [5] https://www.hiv.gov/blog/science-validates-undetectable-untransmittable-hiv-prevention-message https://www.hiv.gov/blog/science-validates-undetectable-untr...

ClarityJones 2y ago
From [5] https://www.hiv.gov/blog/science-validates-undetectable-untransmittable-hiv-prevention-message https://www.hiv.gov/blog/science-validates-undetectable-untr...: > Even when viral load is undetectable, ... may have detectable HIV genetic material in ... semen, but there is no scientific evidence that such material is associated with HIV transmission. What? Isn't that the primary transmission vector?
- toomuchtodo 2y ago
  From that same link you cite: > Findings from the breakthrough NIH-funded HPTN 052 clinical trial, a decade-long study involving more than 1,600 heterosexual couples, offered clear-cut evidence that ART that consistently suppresses HIV also prevents sexual transmission of the virus. In 2011, the HPTN 052 investigators reported that starting ART when the immune system is relatively healthy, as opposed to delaying therapy until the immune system has been weakened by the virus, dramatically reduces the risk of sexually transmitting HIV. The protective effect of starting ART early was sustained over four additional years of follow-up. Importantly, when viral loads were measured, no HIV transmissions were observed when ART consistently, durably suppressed the virus in the partner living with HIV. Wild speculation is that the genetic material you mention is inactivated and therefore unable to transmit the virus, but is still detectable. I am just an internet rando surfing the knowledge graph, but the science appears sound. https://www.nih.gov/news-events/news-releases/hiv-control-through-treatment-durably-prevents-heterosexual-transmission-virus https://www.nih.gov/news-events/news-releases/hiv-control-th... https://web.archive.org/web/20150106032855/http://www.niaid.nih.gov/news/newsreleases/Archive/2011/Pages/HPTN052Breakthrough.aspx https://web.archive.org/web/20150106032855/http://www.niaid.... https://www.clinicaltrials.gov/study/NCT00074581 https://www.clinicaltrials.gov/study/NCT00074581
  - pstrateman 2y ago
    >1,600 heterosexual couples Is there a similar study of gay men who are not in a monogamous relationship? Studying the group with the lowest transmission rate who could still transmit seems kind of dishonest.
    - foldr 2y ago
      It's not 'dishonest'. It's important data for parts of the world where heterosexual transmission of the virus is common. And yes, there is a similar study: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30418-0/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
- deleted 2y ago
  [deleted]
chimeracoder 2y ago
> Longer term, it is likely there will be a shift to a twice yearly injectable (Gilead’s Lenacapavir) That's debatable. Injectable PrEP has been around for years already (Lencapavir is not the first, just the most recent). Lencapavir has also not yet been tested on all at-risk groups, so unlike other forms of PrEP, it's not a universal solution because it cannot be prescribed to all candidates. Given the price, which is quite high even with the programs Gilead has said that it will issue to reduce the cost, it remains to be seen how widely-used Lencapavir becomes outside of specific markets.
- borski 2y ago
  I’m confused. The parent comment said “longer term,” and you went on to discuss how it is not going to be used in the short term, due to the need for more testing and cost. Cost comes down over time, and more testing occurs over time, somewhat by definition. So… what specifically is debatable about the longer term?
  - chimeracoder 2y ago
    > Cost comes down over time, and more testing occurs over time, somewhat by definition. Truvada has been around for over twenty years, and generic for 4-5 years. It still costs $2000/month list price. More testing doesn't just magically happen either. Gilead has chosen for years not to pursue testing, let alone approval, for Descovy in various groups excluded from the original clinical trials. They've decided it's not profitable enough for them. The same could very easily happen with lencapavir, and in fact there's good reason to suspect it will.
    - borski 2y ago
      Why is it so expensive? And is it covered by insurance? If so, then I'm not sure the list price matters all that much from a 'to most people' perspective, even if there is a moral argument to be had here (in which we'd probably agree). I'm not entirely sure what the argument is, though - is it just the cynical argument of "well, these companies don't care about solving problems, just profit, so they're never going to do anything with it"? If so, then at least I understand your argument, even if I don't necessarily agree. But I tend to be an optimist.

nerdjon 2y ago

What I have noticed is that in most situations saying "PrEP" is enough. For my doctor that meant discussing Truvada, Descovy, and what is just kinda dubbed "Injectable Prep". This aligns with most apps also just saying "on prep" with no distinguishing between what prep. I would imagine that if/when this comes to market it would likely similarly fall under "Prep" for the general community and then you discuss the specifics with your doctor. Edit: There is also Doxypep (I just say Doxy), which while related to STD's is not related to HIV.

felixg3 2y ago
There are people announcing their PrEP status on dating apps so they can raw dog with strangers? Have people forgotten that there are plenty of STD besides HIV? I think this is highly problematic and lifestyle PrEP seems to be counterproductive as a public health measure. But I am open to arguments that I’m wrong. It’s possible that I am biased as a monogamous heterosexual who has grown up in a culture where sex without condom, especially outside committed relationships, is generally frowned upon and 1980-1990s HIV scares are still in the consciousness of people.
- iknowstuff 2y ago
  Nobody’s giving or getting head with a condom. People who stay on top of preventative measures tend to not bother with condoms since PrEP became prevalent, because the rest of them you can get with or without a condom due to oral. Preventative: 1. Gardasil 9 (vaccine against 9 strains of HPV, prevents genital warts and cancers caused by HPV) 2. Monkeypox vaccine 3. Meningitis ACYW vax 4. Meningitis B vax (35% effective against gonorrhea) 5. doxyPEP (two pills of doxycycline taken after sex, 90% effective against syphilis, 80% chlamydia, 50% gonorrhea) 6. PrEP (prevents HIV infections) 7. and the usual suite of vaccines against the rest like hepatitis A/B, mumps etc You’ll notice all of these give you far more protection than a condom would. Again, especially since oral is a thing. Treatment of the bacterial ones (which transmit through oral too): 1. syphilis - butt shot of penicillin 2. chlamydia - 1/2 pills of an antibiotic 3. gonorrhea - a week of doxycycline pills or one butt shot of ceftriaxone Remaining unpreventable/untreatable one is HSV. Half of the population has it. Condoms dont prevent it either. Hepatitis requires blood contact and as such is not necessarily considered an STI, but hepatitis c is curable these days thanks to DAAs taken over the course of 8-12 weeks, and a/b variants have vaccines.

preventionexprt 2y ago

[flagged]

nerdjon 2y ago
That assumes that everyone you are engaging with knows their status. If someone knows they are HIV+ and are undetectable than you are more informed about the risk than you are in many other situations. Also, if your partner is positive are you really not going to want to be with someone just for that reason? Really need to get past the stigma around this and focus on education instead. Edit: You changed your comment to no longer mention just not engaging with people who are HIV+...
- deleted 2y ago
  [deleted]
- Vecr 2y ago
  Yeah, or just not "engage" with anyone. Manage risk, assume unknown or not completely trustworthy = positive.
- hyperliner 2y ago
  [dead]
sillysaurusx 2y ago
One doesn’t always know. And besides, if in modern times the risk is essentially zero, then it’s worth considering.

4fterd4rk 2y ago

PrEP - An HIV negative person taking Truvada or Descovy once a day to prevent HIV infection. PEP - An HIV negative person taking a course of antiretrovirals within 72 hours after exposure to HIV to prevent HIV infection. This article is referring to injectable PrEP. This is already available via an injection every two months and is typically used in populations that can't be expected to take a pill every day (drug addicts, etc.). The article is referring to a new form of injectable PrEP that extends this to once every six months.

chimeracoder 2y ago
> This is already available via an injection every two months and is typically used in populations that can't be expected to take a pill every day (drug addicts, etc.). That is a pretty bold parenthetical statement. Not only is it not true that "drug addicts" can't be expected to take a pill every day, but neither cabotegravir nor lenacapavir are tested or approved for HIV acquired through non-sexual means, which makes them a poor choice for PrEP for "drug addicts" compared to oral forms, which are effective against all forms of HIV transmission. Source: former counselor and educator for HIV and substance use
- fragmede 2y ago
  > Not only is it not true that "drug addicts" can't be expected to take a pill every day, The general population can't be expected to take a pill every day, what would make anyone believe people with SUD are able to? Source: person who's expected to take a pill every day, and knows other people who are supposed to taste a pill every day.
  - chimeracoder 2y ago
    > The general population can't be expected to take a pill every day, what would make anyone believe people with SUD are able to? The general population does take PrEP regularly enough to be protected. You seem think that people with substance use disorders are excluded from that, and that belief is grounded in stereotype and bias, not science. Source: clinical data and professional experience

masspro 2y ago

PEP means "post-exposure prophylaxis"; PrEP means "pre-exposure prophylaxis". You take PrEP regularly (if you know you're at risk due to sexual habits etc whatever), but only take PEP in response to a specific possible-exposure event (and not already on PrEP). You want pre-exposure instead of post-exposure because post-exposure is very hard on your body and makes you feel sick.

dyauspitr 2y ago
Why is post exposure so hard on the body. Isn’t it still just a 2 drug cocktail (truvada+another one)?

Eumenes 2y ago

Don't have sex with strangers you don't trust.

barfingclouds 2y ago

Clinics are pretty good. But in general, if you’re a woman in a first world nation your odds of getting it are really low, unless you do significant amounts of anal sex with bisexual men or inject drugs. Same thing with men. Straight men aren’t at much risk. Bi and gay men are at high risk. If you have a hiv+ partner, prep is good enough to keep you safe. Just take it always as prescribed. Pep in for when you may have been exposed, and you need to get it as soon as possible. It’s like a morning after pill. Within 72 hours of exposure but sooner is better. Then for anyone who does unprotected casual sex, there’s doxypep which reduces likelihood of bacterial stds by a lot, so gonorrhea, chlamydia, and syphilis. If you want a person to explain this to you in real life, there’s different clinics in every American city that would love to take the time to teach you about all of this. Part of their funding is to educate