PrEP Update – Sharing Of Meds

A new study showed that about 10% of gay and bisexual men on PrEP shared their meds with others. Usually the men were younger. The concern is that there is less protection for both parties and that the receiver may get resistance to HIV if he has HIV already, because he is not getting regular tests. Also, he is not getting tested for sexually transmitted infections which can have long-term consequences for him and those who have sex with him and their partners. See “Germ Pools” below.
PrEP is easy to get, but some providers are unfamiliar with it so it may take a few phone calls and a specialist to get it. Be persistent.
PrEP is very expensive in the US and many are going back from Descovy® to Truvada® since there is not that great of a difference in possible side effects and the Descovy® may contribute to weight gain when compared to the lower cost generic Truvada®.
PrEP with the long acting injection given every two months was slightly better at preventing HIV than the pills in one study on 4 continents. This injection is not available yet.

They said they were testing everyone frequently and they had the best prevention procedures. However, some in the White House say that mask wearing was minimal, distancing was rare, and testing was less often than stated. The rapid test they used may be only half as accurate as the laboratory-run test (PCR) and hasn’t been approved by the FDA yet. Many in the White House are infected. Look at the rally TV footage and you will see people shouting without masks, shoulder-to-shoulder, like a crowded bar. People moved frequently between groups in the executive branch, moving the virus with them to the new group. This is not isolating.

As a reminder, there are droplets (saliva, snot) and there are aerosols (particles that float like smoke). More and more evidence show that Corona Virus aerosols also infect.
Masks help you and others. If you do not cover your nose or have a vent in your mask, then you are not filtering your breath and that may infect others.

To decrease the epidemic, lower the cases (so we can all go back to normal work, school, and not suffer or die from the virus) we need to quarantine people who have it and can spread it. The rest of us must isolate ourselves (stay away from other people except for necessities).
So if the president spoke at an event, then all those there who were not isolating should be tested and if positive be quarantined so they can’t spread it. These actions help lower the spread:
not shouting or singing
staying outside, avoid buildings, busses, planes…
keeping a good distance between people (isolating means being alone or in your family or small group)
wearing a mask covering nose and mouth without a valve
quarantining people who have it; they stay in their room for up to 14 days.
Quarantinging people who have been exposed until their first test is negative.

The White House is not following through on these measures so one can guarantee spread far and wide.

The same principles apply to tracking and tracing HIV spread. If a couple is monogamous, then no new sexually transmitted infections can enter. If one steps out and has contact with someone from another group or groups, then he can bring the STI to his main partner. For those who have a history of contact with a large group (like the app sex population) then we check them for STIs as frequently as every 3 months or sooner if they suspect they had a particularly risky encounter. For those who are monogamous we may check them for STIs every 6-12 months.

A Chines study released months ago found that smokers caught Covid more easily and died more frequently compared to non-smokers. Call 800-NO-BUTTS OR 800-45-NOFUME for help, Your cigarette purchases pay for this service!

Medscape has 1800 of those who have died worldwide listed by submission with web links to learn more.
“Healthcare workers are on the front lines of the global effort to care for patients with COVID-19, while putting themselves at risk for infection. Thousands have already died, from dozens of countries, professions, and specialties. Here we honor them all.
Physicians, nurses, assistants, technicians, orderlies, administrators, volunteers, drivers, porters, EMTs, firefighters, and more — fresh on the job or retired — they are all remembered here. In some cases, we include names of people who did not die from COVID-19, but whose deaths were clearly related to the stress and demands of the pandemic.”
Stop the dying, let people go back to school and work: Please wear a mask covering your nose and mouth.

Keep those questions coming, Be safe!

Daniel Pearce, D.O., FACOI, AAHIVMS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine
HIV, Hepatitis B,C, Transgender, Suboxone Specialist, Borrego Health (Riverside, San Bernardino, San Jacinto)
Member, Coachella Valley Clinical Research Initiative