How To Take Intermittent PrEP

Intermittent PrEP  also called “PrEP on demand” is a way to take PrEP medication if you find your level of sexual activity is infrequent, your risk of exposure is only for short periods of time – such as travel, or you have significant side effects from PrEP that make taking daily tablets undesirable. (1)

The iPerGay study showed that short term use of Truvada PrEP can be effective using the following schedule (2):

  • Take TWO Truvada pills from 24 hours to 2 hours in advance of an anticipated exposure to HIV.
  • If you do have sex that risks exposure, then take another pill 24 hours after the first dose and another one the day after that.
  • If, however, you have sex that risks exposure again at some point in the two days after the first sex – then keep on taking one Truvada pill per day, until two days after your last sex. Only then stop.

The following video helps explain how to take intermittent PrEP using 3 different examples

Intermittent PrEP Dosing

In A Nutshell:

Take 2 tablets of Truvada 2-24 before sex, then take one tablet every 24h after the first dose till you’ve had 2 days (48h) free from sexual activity.

Time Intervals Between Intermittent Doses

If you have finished your episode of PrEP and then potential sex come up how do you proceed?

  • If it’s less than 7 days since your last tablet you don’t need to take the double starting tablets, just one.
  • If it’s been more than 7 days since the last dose of PrEP you need to start again with the 2 tablets of Truvada

From this point it’s continue as above, one tablet of PrEP every 24 hours till 48 hours has passed free of sex.

Currently on demand PrEP research has looked at gay males and trans women. (3) The Australian PrEP Guidelines note:

It is important to emphasise that on-demand PrEP should not be used in cis-gender women or heterosexual men owing to a lack of data about its efficacy in these populations.

References

How To Take iPerGay PrEP Video Transcript
 Hey guys, it’s Dr. George Forgan-Smith, and today I wanted to talk about the intermittent dosing regime for PrEP. So, in Australia we have been recommending that people take PrEP on a daily basis, a single tablet taken every day. And this works great for people who are having fairly regular sexual activity. If however you are not having regular sexual activity, or if you find that PrEP is leaving you with some side effects, sometimes intermittent dosing could be the way that works well for you.

So, intermittent dosing is per episode taking of PrEP, so you really only take the PrEP during a period where you are having sexual intercourse that could lead to a potential transmission of HIV.

So, I wanted to explain the process. It’s quite straightforward, basically you start by taking two tables of PrEP, two to twenty-four hours before you think you’re going to be having sexual activity. Then, if you do have sexual activity you take a single tablet of PrEP every 24 hours until there has been 48 hours of intercourse free time.

Say for example you’ve heard from a friend and you’re looking forward to catching up i think them on Saturday. Let’s have a look at a calendar and see how this would work. So, Saturday morning you hear from your friend, it’s about two to twenty-four hours before you’re going to catch up with your friend, so you would take your two tablets of PrEP, say Saturday morning.

Then, Saturday evening you catch up with your friend and you have sexual intercourse. You then take one tablet of Truvada, 24 hours after you took these first two tablets, and then you have a second tablet of Truvada, again 24 hours after this tablet. So you’ve had two tablets, and then the next tablet 24 hours later, and another tablet 24 hours later.

So if you’ve only had the sex on the Saturday, you would stop taking the PrEP on the Monday. If you had sex on Saturday, and on Sunday, then you would need to take an additional tablet of PrEP, because we want to make sure that we have 48 hours free from sexual activity.

Say for example you took your two tablets and had sex on the Saturday, then you didn’t have sex on the Sunday, but you did have sex on the Monday. Again, you need the 48 hours of sexual activity free, and that’s a single tablet of PrEP every 24 hours. Sex on Saturday, no sex on Sunday, but you did have sex on the Monday, then you just need to make sure that you take a tablet of PrEP on the Tuesday and a tablet of PrEP on the Wednesday.

Of course, be sure to talk with your doctor about whether intermittent dosing is for you. It is generally good for most people, the only people who should not be on intermittent dosing are people who are living with hepatitis B infection, because going on and off of the Tenofovir and Emtricitabine can effect the hepatitis B virus. If you would like to learn more about intermittent dosing and prep, be sure to talk with your doctor to make sure you have a full understanding on how it works. I hope this was helpful.

Taking PrEP When Travelling Overseas

Travelling With PrEP

Travelling With PrEPIn this video I wanted to explain the best way to take PrEP when travelling, in particular when you are crossing time zones.

As noted in previous videos, Truvada for PrEP is a robust treatment and occasional changes in time of dosing will not have a major impact on it’s protection against HIV.

I recommend all people continue to take the medication at the same time they would normally take the  medication.

  • If you take your PrEP in the morning continue to take it in the morning.
  • If you take it before bed continue to take it before bed.

When changing time zones the trick is:

  • If it’s been less than 12 hours since your last tablet but it’s the time you would normally take it at your new destination, skip this one dose and take the next dose at the time you would normally take it.
  • If it’s been more than 12 bours since your last dose and it’s now the time you take the medication in your new time zone, take the tablet and continue to take the medicine at the same time each day.

For Example…
If I am flying to the USA from Australia, I take my PrEP in the morning before I head to the airport.
My flight is usually around lunch and then it’s a 14h flight to the USA.
Normally I arrive at the morning in the USA when I would normally take my PrEP. On this day as it’s been more than 12h since the tablet (acuatlly pretty close to 20 hours), I just take the PrEP and continue to take it at the same time each day.

I hope this has helped explain this process.

Also of note, when travelling be sure to carry your medications in the bottle it was supplied with your name and drug information on the sticker.

I like to carry a letter from my doctor as well explaining why I am taking the drug.

Remember some countries have laws around people living with infections such as HIV so it can be helpful to have this letter to explain whey you are taking PrEP.

Of course if you have any questions, be sure to talk with your doctor before heading over seas.

Happy Travels!

Dr George Forgan-Smith

“Video
Hi guys. It’s Dr. George at Forgan Smith, from ispreforme.com. And today I want to answer the quick question about how do you deal with taking PrEP when you’re travelling overseas? In particular, when there’s significant changes in timezones. Now PrEP is a very robust system. There’s a lot of leeway in there. So what I would recommend is the following. If you take the tablet at the same time every day, i.e. in the morning, just continue taking it in the morning. Say for example, if you’re flying from Australia to America, you could take it the morning before you fly. And when you get to America, often you’ll arrive in the morning as well. If it is has been less than 12 hours since the last tablet you took, I would just leave it and take the next tablet the same time you normally would. But if it’s been more than 12 hours, don’t worry about it. Just take the tablet at the same time you normally would.
​So if that sounds a little bit confusing, if you take it in the morning, just continue taking the tablet in the morning. If you take it at night, continue taking the tablet at night. If there is a bit of an extension between tablets, say it’s been 26 to 28 hours between tablets, it’s okay. You will still be very well protected against HIV with your daily PrEP tablets. Of course, if you have any questions, worries or concerns, be sure to talk with your doctor before you travel. Other important travel tips when you’re travelling with PrEP is, it’s important, keep your PrEP in the bottle that it was provided with, with the sticker that has your name on it.
​That’s important so you can prove that it’s a prescribed medicine for you. The other thing is that it might be worthwhile considering getting a letter from your doctor, that explains the medication and why you are taking it. In some countries in the world, there can be medial legal issues if you are HIV positive. So it is important that you have some sort of letter that explains that you are not HIV positive. You are taking PrEP as a prevention tool. So these are important things to be aware of before you’re travelling with medications like PrEP. Hope this is helpful. Have a good one.

 

How To Check For Drug Interactions With PrEP

In this video I just wanted to share how to quickly check for any interactions between PrEP and prescription medications you may be taking.

While Truvada (Tenofovir & Emtricitabine) are a well tolerated medication there are a few drugs that can interact. In particular, medications that can affect the kidneys are always worth checking with your doctor.

The site I recommend to check for drug interactions is the University of Liverpools site:

HIV Drug Interaction Checker

For users of PrEP you can either choose to use the trade name – Truvada,  or it’s individual medications – Emtricitabine & Tenofovir-DF. Once checked off you can then go to the second column where you check the other medications you wish to check. Don’t forget there are generic versions of Truvada such as Tenvir-EM and Ricovir-EM, both are commonly used in Australia for those who import PrEP.

  • Green bars for each drug indicate no drug interactions have not been noted.
  • Yellow/Orange bars indicate potential drug interactions.
  • Red bars indicate well established drug interactions and are best avoided with the HIV drugs you have checked.
  • For people living with HIV as well as those on PrEP this is a very helpful site to ensure any potential drug interactions can be avoided.

Of course remember that we are all individuals and we can all have unique responses to different medications. For this reason it’s important to discuss all new medications with your doctor, even ones over the counter.

There can be serious drug interactions between some HIV medications with party drugs so again, talk with your doctor to help avoid harm.

Dr George Forgan-Smith

Don’t Take PrEP With Metamucil

Don’t Take PrEP With Psyllium (Metamucil™)

One important thing that I would like to note is the combination of Metamucil™ or psyllium husks and PrEP medication. When you take cilium husks, it’s designed as a way of helping keep bowel movements regular. It’s normally a teaspoon that’s mixed into a glass of water. It creates a gel-like substance inside the gut that helps absorb water and make your poo nice and soft.

The issue is, when you take medications with Metamucil, that the medicine can get caught in the centre of that jelly-like substance, making it harder for the drug to be absorbed. It’s very, very important when you’re taking PrEP and Metamucil, don’t take them at the same time. I recommend, say, take your PrEP in the morning, and you’re using Metamucil, take the Metamucil in the evening, or at the very least, four hours after you’ve taken your PrEP. That will ensure that you have plenty of time for the PrEP drugs to be absorbed into the body before the jelly-like substance of the Metamucil comes through the gut.

How Much Truvada Can I Legally Import Into Australia?

How much PrEP can I legally import into Australia?

Currently, it is legal to import PrEP into Australia. However, it’s important to note you can only bring in 90 days worth of medication in at a time. This works out conveniently because, as part of the PrEP follow-up, it is important to be getting a checkup every 90 days. It works out well.

What I say to my patients is you place your order for the PrEP. As you get towards the middle of your second jar, that’s a great time to come in and get a full sexual health screening, your new prescription for PrEP, and this gives plenty of lead time to make sure that if there are any delays in bringing the medicine into Australia, that you’re going to have enough time. That way you won’t have any episodes where you may run out of medicine.

Are There Drug Interactions With Truvada I Must Be Careful Of?

Are there any supplements or other medications that I need to avoid when taking prep?

It’s important that, when you start prep, that it is prescribed by your doctor and they can look at all of your medications and check for any interaction that could be present.

If you are starting a new drug that may not be prescribed by a doctor, for example, something over the counter, one website that can be extremely helpful is HIV Drug Interactions: http://hiv-druginteractions.org

This is a great website, and you simply put in the information about the new drug that you’re taking, as well as Truvada or Tenofovir/Emtricitabine, and it will bring up any potential interactions that are with that drug. If you have concerns about interactions, please talk to your HIV prescriber to make sure that everything is looking good.

Important Points Before Starting PrEP

Before you start taking PrEP it’s important to cover some important key points:

Below is a series of short videos that will answer the most common and important questions about Truvada and pre exposure prophylaxis in just 9 minutes.

Each clip covers an important concept to help you decide if PrEP is for you.

  1. What is PrEP?
  2. What tests are needed before starting PrEP?
  3. Common side effects of Truvada™ PrEP.
  4. How to take PrEP.
  5. How long to take PrEP before you are protected against HIV infection.
  6. Does PrEP protect against other STI’s?
  7. Recommendations for condoms when taking PrEP.
  8. Follow up guide for seeing your doctor.
  9. What to do if you wish to stop taking PrEP

  • PrEP can reduce the risk of HIV infection by 99%, however you need to take the tablet every day
  • Before starting PrEP you do need to have important baseline testing to check you are HIV negative, your kidneys are healthy and to check for Hepatitis as well as potential sexually transmitted infections.
  • PrEP only protects against HIV infection. It does not protect against other sexually transmitted infections. Use of condoms can reduce the chance of other STI’s.
  • PrEP can have some side effects infrequently: Some people experience gastric upset when they first start taking the medicine. Rarely kidney function can be affected.
  • World wide there have been people who have become HIV positive while taking PrEP. By far the most common cause for this has been not taking the medication as prescribed. There has been 2 rare cases of infection with a strain of HIV resistant to both drugs in PrEP (Tenofovir & Emtricitabine).
  • When you are taking PrEP you require regular appointments with your doctor every 12 weeks for full sexual health screening, kidney function testing and to check for any issues with the medications.
  • If you are planning on stopping PrEP it’s important to continue taking the medication for 28 days after your most recent potential exposure to HIV before stopping.

ASHM PrEP Guidelines 2017

How Do I Buy PrEP In Australia?

How do I access PrEP in Australia?

Currently in Australia there are a number of different ways that you can access PrEP. There are firstly, a number of studies happening in Australia. If you’re able to be enrolled in one of these studies, it means that you will be supplied with the drug, either for free or at a very economical rate.

Part of being in the study means that you will need to sign consent forms, as well as be available for regular screening check-ups. Every state in Australia does have a PrEP study at the moment, so it’s important you contact your local AIDS organisation and they will be able to help you learn more about the studies that are available. I’ll put links underneath this video that show where the studies are currently in Australia.

If you’re not eligible for a study, another way to get PrEP is to import it into Australia. This can be legally brought into Australia from companies around the world that are supplying generic Truvada. This can range in pricing, ranked from $37 US a month, up to about $70 US a month and the prices are very dynamic. There are a number of different ways you can access and I will place a link to a great website here in Australia, pan.org.au PrEP Access Now. They have lots of up-to-date information on how you can import PrEP in to Australia.

Finally, the last way you can import PrEP or get PrEP in Australia is to buy it directly. In Australia that would be buying Truvada. It is quite expensive, it ran about $600 a month.

How Do I Import PrEP?

How do I import PrEP into Australia?

If you are going to import PrEP into Australia, it’s very important that you have a conversation with your doctor, who is familiar with PrEP. They will be able to provide you not only with a prescription for a PrEP but you will also be able to get some information on how to import it. When you are buying from overseas, you will be purchasing generic Truvada. Generic Truvada is exactly the same as regular Truvada. However, it’s made in companies that have been licenced by Gilead, the creator of Truvada. Under this licence, they can produce the generic PrEP that you can import into Australia.

Recommended Generic PrEP Providers

Green Cross Pharmacy

Green Cross Pharmacy

Tenvir EM Or Ricovir EM

Current cost for 3 month supply $70.15 USD

Dynamix International

Dynamix International

Tenvir EM or Ricovir EM

Cost for 3 month supply $95.00 USD

Pulse Clinic

Pulse Clinic Bangkok

Teno EM or Ricovir RM

Cost for 3 month supply $151.00 USD

When you’re bringing medications into Australia, there are a few things that are important. One, you do have to have a prescription by your doctor. You then go to one of the many websites where you can buy PrEP online. Pan.org.au is a great website that lists the current places you can buy PrEP online. When you place an order, you will often have to send in a copy of your prescription. That’s easy to do. Take a photo with your phone and you can send that photograph along with your order proving that you have a medical prescription to be able to bring it into Australia. It’s important. Keep that script, because when the drug comes into Australia, customs may ask you why you’re importing it and you can say, “I have a prescription from my doctor and this is how I’ve been able to obtain it.” Do not ask for more than 90 days worth of medications. The legal limit to bring into Australia is 90 days. Anything more than that will be stopped by customs and could be destroyed.

Learn more about importing PrEP and purchasing online here @ PrEP Access Now:
http://pan.org.au/get-prep/buy-prep-online/

Need help making PrEP more affordable? PrEP Access Now can help with their assistance scheme:
http://pan.org.au/assistance-scheme/

How Do You Start PrEP?

How Do You Get Onto PrEP?

When you’ve made the decision that PrEP may be a drug for you, it’s important to get in contact with a doctor. Here in Australia, PrEP has to be prescribed by a medical doctor. You cannot order it online without a prescription. So, this is an opportunity for you to have a talk with your doctor about your own circumstances and your own particular risks of infection with HIV. Before persons can start taking PrEP, it’s very, very important that we check a couple of parameters.

First things first, we need to be absolutely sure that you are not HIV positive. For this reason, we will do HIV testing before you start. If you have had a potential exposure to HIV close to the time that you want to start taking PrEP, we may need to do HIV testing a little bit more frequently to be 100% sure that you are not HIV positive. If you are HIV positive starting PrEP, it’s not ideal and you need to be on HIV treatment rather than HIV prevention.

Other tests that we routinely do when starting PrEP is that we want to make sure that you are not infected with hepatitis or other sexual transmitted diseases. At the start of every person starting PrEP, I like to do a kidney function test, hepatitis A, B, and C. I also do a full sexual health screening and this includes a swab of the throat for chlamydia and gonorrhoea, a swab of the bum for chlamydia and gonorrhoea, a urine test for chlamydia and gonorrhoea, as well as bloods for HIV, syphilis and as I said we do check for also hepatitis A, B, and C status.

Who Should Take PrEP?

Who should be considering PrEP?

People who are interested in PrEP are number one people you should be talking to about PrEP. However, there are a number of groups of people who could benefit from PrEP. Primarily, HIV is a disease within the gay community of Australia, within men who are having sex with men. In particular, HIV is highest risk for people who are having condomless anal sex, whether they be the top or the inserted partner, or the bottom or the receptive partner. Both of these positions are a risk for development of HIV. So both of these groups of people should be considering whether or not they want to go onto PrEP.

The main groups of people that we are targeting for PrEP are, people in serodiscordant relationships, somebody who’s got an HIV positive partner when that person is HIV negative. Somebody who’s unreliably able to use condoms on a consistent basis, and somebody who has recently had a diagnosis of either rectal gonorrhoea, rectal chlamydia or syphilis. These are all risk factors, putting the person at a higher risk of developing and exposure to eventual infection perhaps, of HIV. This is a group of people that you definitely want to be talking to about PrEP.

How Do You Access PrEP In Australia

How Do I Get PrEP In Australia?

How do people access PrEP within Australia?

There are three pathways currently for accessing PrEP. The first and the most common one is involvement in one of the studies that’s happening in Australia. Queensland, New South Wales, Victoria, South Australia, Western Australia and the Northern Territory are all participants in a variety of different studies that are looking at PrEP. These studies aren’t necessarily looking at is PrEP effective. We already know that PrEP is effective. However, they’re looking at the way that it’s used within our community, so what it does do is that it enables people to get access to the drug much, much easier.

The primary ways, if you’ve got somebody who’s interested in going on PrEP, first, try and see if you can get them on to a study. This makes their life a heck of a lot easier and connects them into an infrastructure to be able to get their regular screening that’s required. If this person is not eligible for a study, then another way to get PrEP in is to import it into Australia and I will create a video that explains exactly how to do this. You can legally import generic PrEP or Truvada into Australia, 90 days’ worth of medication at a time, and I’ll talk about the ways to do that in a subsequent video. Finally, the last way that people can access PrEP here in Australia is to actually buy Truvada directly. However, this is expensive at over $600 a bottle. Not many people will opt for this choice.

Can I Get PrEP In Outback Australia?

Can people in rural Australia access prep?

Currently, the studies are working very, very hard to recruit doctors in rural Australia to ensure that all Australians at risk of HIV infection are able to access this medication. All doctors can actually prescribe prep if you are going to be importing it into Australia. It would be great to have more doctors who are recruited and who are educated, and who are trained in how to prescribe prep.

Part of the reason for this project is to help ensure and recruit more doctors with an interest in offering prep to patients, no matter where they live. However, if you are in rural Australia, you can absolutely import prep into your town, no matter where you are. The trick is finding a doctor who is willing to learn how to set up the schedule to ensure that you are getting the best care available for your prep journey.

How Often Do I Need To See The Doctor?

How often do I need to be followed up when taking PrEP?

When taking PrEP, it’s very, very important that you have a regular check-up every three months. This is an opportunity not only to give you your new script for PrEP, but also to check for any potential exposures to HIV, as well as other STI’s.

Routinely, we also check kidney function, so you can expect every three months to come in and you’ll be getting a full screening. This will include a throat swab for Chlamydia and Gonorrhoea, a rectal swab for Chlamydia and Gonorrhoea, urine tests for Chlamydia and Gonorrhoea, and blood tests. We’ll be checking kidney function as well as HIV, Syphilis, Hepatitis C, this is an important regular screening, as it helps ensure that you are taking the medication in a way that’s optimal and safe for you. It’s also a great chance for you to be able to ask any questions or bring up any potential side effects that you are having with taking PrEP.

Can I Miss A Tablet If I Have To Fast?

What If I Need To Fast?

If I need to be fasted for say a blood test or an operation, will missing a dose make me at risk of HIV infection? The occasional missed dose of Truvada is not going to cause major harm. What we can say is say, for a blood test, if you need to be fasted in the morning, it’s okay. You can get the blood test done and then after you’ve had your tests, take your medicines as you normally would. If you are fasted, say, for an operation, it’s perfectly okay to be able to take the medicine after the operation, say, if it’s six hours after you’d normally take it, that’s okay. However, if you do miss the occasional tablet, it’s not that big a deal. You will still be protected against HIV.

It’s when you start taking less than four tablets a week that the protective effect of Truvada drops off rapidly.

How Should I Take PrEP?

How do I take PrEP?

There are a number of different studies that look at ways that you can take PrEP. However, here in Australia, our recommendation is that PrEP should be taken every day. When PrEP is taken every day, what we know is that there is enough drug within the system to reduce the risk of HIV infection by up to 99%. It’s very important that you find a regular routine to take the tablet. For some people, I say find something that you do on a reliable basis every day and then attach taking that drug at that time. For example, if every morning you have a coffee, take your drug, put it beside the coffee jar as a reminder to take the medicine every day. Sometimes, using an app on your phone can be helpful as a reminder to take your tablet. It may also be useful to get a small container and place one or two tablets of your PrEP inside that container and throw it into your work bag. That way, if you forget to take a tablet, you’ve got one with you and you can take it straight away.

So I Can Stop Using Condoms?

Does being on PrEP mean that I can give up condoms?

Often, the reason that people are going onto PrEP is because they weren’t actually using condoms to start with. What we have found is that if a person is using PrEP as their protection against HIV, if they don’t use a condom or a condom breaks every now and then, they will still be protected against HIV. We do recommend that people continue to use condoms, because they can help reduce the risk of other sexually-transmitted infections, such as chlamydia, gonorrhoea, syphilis, and even herpes. They don’t absolutely protect against these transmissions; however, they can help reduce them.

Is PrEP Just For Gay Men?

Is PrEP only for gay men?

The answer is no, PrEP is not just for gay men, it’s for all people who are at potential risk of HIV infection. This includes men who have sex with men, trans men, trans women, as well as female heterosexuals. For women or owners of cervixes, we recommend that people are taking Truvada for at least 21 days before they will have levels that offer the best protection against HIV.

It’s important that you talk to your doctor to make sure that you are getting the correct information when it comes to the dosage of PrEP, and how long you need to be taking it before you are offered full protection against HIV.

Do I Take Truvada With Food?

Do you need to Truvada with food?

The answer is no, you don’t need to take the drug with any particular time of day or any particular food. The most important thing is that you find a way to take the tablet every day. If, ideal, you take it at the same time every day, not necessarily because of urgency or timing, but it’s about setting a routine, setting a regular practise that you have so you will always remember to take your drug every day. And when you take it every day, we know that it reduces the risk of HIV infection by around about 99%.

Is Daily Tablet The Only Way To Take PrEP?

Are there other ways of taking Prep other than a single daily tablet?

There have been studies done worldwide that looked at other dosing schedules which include taking two tables of Truvada before you’re thinking about having sexual activity, usually two to 24 hours before activity and then one tablet every 24 hours for two days after the sexual activity. This has shown to have a good effect, however there is still ongoing study in this area and currently in Australia, our recommendation is to take the tablet every day.

What If I Miss A Tablet Of PrEP?

What happens if you miss a tablet of PrEP?

The good thing is that there is a bit of leeway when it comes to taking PrEP. If you are missing a tablet every now and then, it’s not that big of deal. You will still be protected for HIV. However, we do recommend that you take the tablet every day.

If you get to a point where you’re finding difficult to take the tablet or the amount of tablets you are taking drops below, say, four tablets a week, your protection on HIV is greatly reduced.

It is important to take the tablet every day. If you discover during the day that you may have missed a tablet, it’s okay. If it’s been less than 12 hours from the time that you would normally take the tablet, just take one straight away. If it’s been more than 12 hours, it’s okay. You’ll still be protected against HIV. However, do make sure that you take your tablet at the regular time the next day.

How Do I Stop Taking PrEP

What Happens If I Want To Stop PrEP?

If you’ve had a change in situation, where you feel that you are no longer at risk of potential infection with HIV, you are able to stop taking PrEP. However, the recommendations are that you need to take the drug for at least 28 days after your last potential exposure to HIV. This will help ensure that if there have been any particles of HIV in the body that they are able to be fully killed, fully gotten rid of, before you stop taking the tablets.

Should I Increase My PrEP If I’ve Very Sexual?

Should I increase my dose of PrEP if I’m having lots of sex?

The answer to this question is no. You need to continue taking the PrEP exactly as it was prescribed. One tablet a day is more than enough to protect you against HIV, no matter how much sexual activity you are having. Increasing the dose does not increase the amount of protection that you are offered.

Do I Double Up My Truvada If I Miss A Tablet?

If I miss a tablet of PrEP one day, should I double up the next day?

No. The good news is that there’s a bit of wiggle room when it comes to PrEP, so if you miss one day, it’s okay, you don’t need to take two tablets the next day.

You just take your tablet as you normally would, and continue forward. It might be worth considering perhaps putting an alarm in your phone, to help remind you to take the tablet every day.

I usually recommend that people have a little pill container that they carry in their bag, with one or two extra tablets in there, that way if you forget to take the tablet in the morning, you do have one spare with you, should you require it.

How long after starting PrEP do I need to wait before I will be protected HIV?

How Long Before Truvada Will Protect Me Against HIV Infection?

When you start taking PrEP, it takes a little while for the concentrations of the drug to get higher in the blood but also in the tissues of the body. For gay men, it’s around about seven days that you need to be taking the drug before it’s able to offer full protection. In women and trans men, you do need to be taking the drug for up to 21 days before you are offered full protection against HIV.