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Prep and chem sex

Mar 7, 2017

Hi Doc,

I was wondering whether there is any significant interaction between Prep and chemsex?

Response from Dr. Fawcett

Thanks for your excellent question about interactions between chemsex and PrEP. Chemsex is the use of certain recreational drugs in conjunction with sex and, by definition, almost always high-risk sex. The drugs most frequently used are methamphetamine, cocaine on occasion, GBH (Gamma Hydroxybutyrate), and (mostly outside the US), mephedrone. Depending on availability, price, and law enforcement efforts other drugs may be substituted for these.

In my opinion, chemsex is almost always high-risk. I know some people who say they can safely indulge once or twice a year but I know of very few who have been able to successfully maneuver that fine line without getting into trouble. Not only is high-risk sex an issue, but users frequently move quickly to injecting drugs, thereby introducing another HIV risk. And to make matters worse, people often are too distracted to take their medications, whether HIV meds, antiobiotics, or PrEP.

As to your question, PrEP consists of two antiretroviral drugs in one pill called Truvada (consisting of emtricitabine and tenofovir disoproxil fumarate). Some chemsex users have found it difficult to obtain a prescription for Truvada (as PrEP) because prescribers are concerned about the buildup of resistance to the drug based on the potential for skipped doses mentioned above. Given the results of the IPERGAY study, which showed that PrEP is effective even at less than daily doses, I think this should be less of an issue. Drug interactions with antiretroviral drugs have not been effectively studied, but the most significant interactions with chemsex drugs (particularly meth) are with Protease Inhibitors, not an issue with Truvada.

The bottom line is that a chemsexer who is still HIV negative needs the added protection of PrEP. There are risks of missed doses and each case should be evaluated on its own merits, but PrEP should be considered an additional tool available to help.

If you're interested you might check out this article I wrote on chemsex, PrEP, and approaches to these issues in France.

Thanks and take care,

David



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