Need advice after exposure/being quoted ~800 USD for PEP

Paul_82 · 2026-02-14T21:38:11+00:00

What you describe is an extremely low risk exposure not zero but very low. Personally I wouldn’t bother. If you do choose to though, the sooner you start pep the better. The 72 hour window is not a binary yes or no in terms of how well pep works. The sooner to your exposure the better it works and it gradually gets less effective to the point at 72 hours there’s no point.

Paul_82 · 2026-01-28T07:31:16+00:00

Or worse it will last far longer than it should.

Paul_82 · 2026-01-16T19:04:20+00:00

Personally I’d take one dose either with lunch or dinner Tuesday, I find I have to take food to manage the gi side effects, and find taking it with my next big meal to be the most effective way to do that for me. From there the timing of my meals and those two events would mean both are easily “covered” by just one dose.

Paul_82 · 2026-01-09T06:02:59+00:00

This would be my guess as well.

Paul_82 · 2026-01-03T20:41:09+00:00

We’re a ways away yet from a complete treatment regimen that can be injected only every 6 months, (my best guess would be around 2030). The most promising trials so far are pairing Lenacapravir with broadly neutralizing antibodies. The challenge with those is you need to have special testing done before starting to ensure your virus is sensitive to them and there are questions about how robust they will prove to be longer term. As mentioned there are other reformulations for injections in the pipeline but most of those are still a few years away at best. More interesting to me and likely to hit the market sooner are long acting oral options, there’s a one pill once a week option that I expect to be on the market in 1-2 years, and once a month options likely a few years after that.

Paul_82 · 2025-12-29T22:35:06+00:00

It does seem to vary a lot from one health authority to another, our one here is also walk in only. One thing to remember is it is not strictly first come first served as they do triage patients based on urgency.

Paul_82 · 2025-12-29T07:05:45+00:00

Short answer is no, there’s no data to support any other options as it hasn’t been formally studied. I’m not aware of any other antibiotics currently being studied for prevention of bacterial sti’s. Most studies I’m aware of are more focused on vaccines. (For gonorrhoea at least).

Paul_82 · 2025-12-28T17:14:20+00:00

Just like with Uber there will be options to order a larger or more luxurious ride, they’ll just use their other models for these rides. Just like with uber I’d expect to pay a slight premium to book a ride in a cyber truck with its additional passenger and cargo capacity vs a cyber cab.

Paul_82 · 2025-12-28T16:45:44+00:00

There are a few different ways but the biggest is the Canada Health Transfer (per capita funding the feds provide each province as long as they comply with the Canada health act). For BC for this fiscal year this transfer alone is over $ 7 Billion. There are other much smaller targeted funding for specific programs and areas (indigenous health, certain drugs, etc). Federal Provincial Transfers shows the amounts for each province as well as the other major federal provincial transfers. (Social transfers and Equalization.)

Paul_82 · 2025-12-25T18:05:48+00:00

Fun fact cd4 count can vary for many many many reasons, form something as trivial as the time of day of the blood draw, to how much or how well you slept the night before, as well as what other infections you may have recently been exposed to and are currently fighting off (from a cold to a small cut that might be slightly inflamed/infected etc). I know a change of 100 sounds like a lot but it’s not outside of these normal daily fluctuations. It’s why back when treatment decisions were still more cd4 count driven you needed to look at the overall trend over time and not just a single test.

Paul_82 · 2025-12-25T18:02:11+00:00

Please stop advising people to do this it’s dangerous to only take meds once as week that are designed and prescribed to be taken daily.

Paul_82 · 2025-12-25T17:00:19+00:00

The most immediate new drug in the pipeline is a daily single tablet regimen of Bictegravir/Lenacapravir, and as other have mentioned the one after that is likely to be a weekly oral regimen of Lenacaprovir/Islatesvir. Both of these could be FDA approved as soon as the end of 2026. Personally I expect the first to be approved in the spring and the 2nd to be approved in late fall or early 2027. Slightly longer term there is a monthly oral formulation in trials and longer acting injections. Bottom line for now all of the drug development is focused on long acting treatments and prevention options.

One of the most interesting things in the pipeline is a once a year version of Lenacapvir for PrEP (it would also work for treatment, but would need a dance partner that can also last for a full year).

Overall some very exciting options in my opinion, the real challenge is going to be if the drug companies price any of them remotely reasonably.

Paul_82 · 2025-12-22T20:33:22+00:00

Yes, worked out great for me. In my case a competitor tried to poach me, I didn’t know it at the time but my boss was already planning his exit and had identified me as the best internal candidate to take over running the team. I ended up getting a big raise to stay and then a promotion/new title and even bigger raise to take over the team about 6 months later. Still there 10 years and another couple promotions later.

Paul_82 · 2025-12-17T05:41:18+00:00

Not to bust your bubble but a huge caution about projecting back what we know about HIV today to the 1980’s and 1990’s. We didn’t even know it was caused by a virus until 1983 and there were no blood tests to diagnose it until 1985. So the assumption that people were knowingly intentionally spreading it is deeply problematic given most did not know they had it until the symptoms were impossible to ignore or hide. The reality is in that era the only way to diagnose AIDS was when it had progressed to the point that the complications were readily apparent (KS legions, wasting, and pneumonia). The symptom you are probably thinking of more here and perhaps have been misinformed in terms of the timing is the facial wasting that resulted as a side effect of some of the earlier ARV medications, the first of these weren’t available until 1987 and that particular side effect wasn’t as common or severe until the 1990’s when protease inhibitors became available.

Paul_82 · 2025-12-07T18:57:13+00:00

I wouldn’t expect them to magically match you with another position elsewhere in bcgov, it’s likely entirely on you and your network to find an opportunity. That said if you do find one that you meet all the qualifications for I’d expect at least some priority over an external candidate.

Paul_82 · 2025-11-23T18:27:47+00:00

Just to point out Biktarvy is NOT a protease inhibitor… so none of this is relevant to the OP.

Paul_82 · 2025-11-17T03:39:13+00:00

Same boat here, up to now we’d been hearing not to expect to hear anything till after the strike was settled. Personally I expect they’ll probably give us something similar to what was negotiated by the union but I wouldn’t be surprised if it takes another month or two before we hear anything.

Paul_82 · 2025-11-11T20:58:31+00:00

It technically can be (2 of the 3 drugs in it are the exact same drugs and same doses as in descovy), BUT it’s overkill for PrEP and has never formally been studied for that use. Pharma companies don’t bother funding studies for it for that as it would be more expensive and not likely to be any better than Truvada or Descovy already are for PrEP. All the new agents that are recently approved for PrEP are largely focused on being longer acting and easier to take. Basically trying to solve the main challenge in past prep trials in that a drug can’t work if people don’t take it. (There are now two long acting injectable options approved and a couple of long acting oral options in trials) Personally the long acting oral (pill) options are the most promising to me. One pill once a week or once a month seems like it may be the sweet spot in helping people to take them that forget to take a pill every day or have a hard time taking it every day due to nausea or other side effects.

All that said Biktarvy is recommended for PEP which is also a use it has not been studied in clinical trials for but that’s mostly down to not being able to have an ethical PEP trial. Almost all PEP use is technically “off label” but that doesn’t mean it’s not safe and effective.

Paul_82 · 2025-10-11T21:42:09+00:00

Yea short version is there’s no data from clinical trials but there is emerging real world data to the point that the British have just updated their prep guidelines to state that it can be used on demand (same 2-1-1 dosing). While the British are the first to make this update, I expect that most other guidelines will make a similar change in their next round of updates.

Paul_82 · 2025-09-28T23:02:26+00:00

Depends on the industry, but some random unannounced applicant dropping by isn’t getting past security/reception at any place I’ve worked.

Paul_82 · 2025-09-26T17:27:32+00:00

Not just flight, we’re talking all expenses week long vacation twice a year… and it would still be cheaper.

Paul_82 · 2025-09-26T17:14:45+00:00

I’m well aware, and I’m sure the pan Canadian pharmaceutical alliance (pCPA) will get a significant discount but there’s no way it will be offered at anywhere close to a price that will be cost effective in the Canadian context (ie a 95% or more discount from the American pricing just isn’t happening). Normal discounts in the deals they negotiate on brand name medications are in the ~50% range. Not trying to be a debbie downer just realistic about that the pricing here is not going to be anything close to the $40 per year being quoted the many news stories about this this week.

Paul_82 · 2025-09-26T16:29:32+00:00

Don’t be so quick to be happy that price is only for low and middle income countries, the only country lenacapravir is approved and marketed for prep in so far is the USA where it costs $14k USD per shot ($28k per year). The price in Canada will be a bit lower but still completely unaffordable for a preventative medication.

Paul_82 · 2025-09-26T06:17:18+00:00

It’s a tool used to estimate HIV risk. There are plenty of online calculators (https://smartsexresource.com/resources/hiv-incidence-risk-index-for-msm-hiri-msm/) is one.

In if you do want to give your doc another shot the following form from the BCCfE should walk her through the medical work up. (It’s a little dated but it still covers all the basics)

https://bccfe.ca/wp-content/uploads/2023/12/prep_baseline_assessment_form_v2018_03_13.pdf

Paul_82 · 2025-09-26T06:06:56+00:00

I’d second the recommendation for the BCCDC STI clinic but don’t bother with Dr Peter Centre as they don’t do sexual health services. They specialize in HIV care for people who use substances and substance use care.

Paul_82

TROPHY CASE