The New Meaning Of “I Want My MTV”
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11 March 2009 | 29 Comments
Just saw a story on The Sword that there’s a club drug mix out there now called MTV that combines Meth, Tenofivir (and anti-retroviral) and Viagra that neg barebackers are taking when they spend the night partying and barebacking… Meth to get high, Viagra to stay hard, and Tenofivir as a form of “PrEP”.
In case you don’t know anything about PrEP it’s an offshoot of PEP. PEP is the course of HIV meds that you take after being exposed to HIV. Used sparingly PEP is a good thing (though it’s a bit of a joke if you’re a bottom who regularly takes anonymous loads). PrEP takes that a step further an instead of being post-exposure it’s pre-exposure… If you’re the type of person who takes a lot of risk, you theoretically take HIV meds just like poz guys do so you won’t get HIV.
Let me put this bluntly – while you can make whatever choice you want, personally I think PrEP is a crock of shit and I’d never take it – even if I was a bottom. While the ARVs are far better today than they were 10 years ago, they still can have some serious side effects. It’s possible that the PrEP you take today could have worse long-term impacts than becoming HIV positive.
IMHO, the fewer meds I take the better. In the past I always said if I became poz I wouldn’t take meds until I clearly needed them. Now I’m not sure what I’d do. I might take a mild ARV, but I’d first want to get a sense for what HIV was doing in my body. If I could stay off meds I would – for example if it was clear that the strain I had was particularly mild.
One of my big issues is that doctors are putting people on ARVs immediately after diagnosis. They say it’s because it’s best for the patient, but I really think it’s because the meds stop them the person from spreading HIV. It’s clearly best for the community, but I don’t quite believe them that it’s best for the individual patient. [And yes, this is where my selfish American side comes out. A European would likely have no problem taking meds because it’s in the best interest of the community.]
The other problem with PrEP is that you can build up a resistence to ARVs and when you do become poz your treatment options are less. That’s not a good thing at all.
In the case of guys who take MTV or other forms of unsupervised, recreational PrEP they’re in an even worse position – their intermittent use of ARVs will most definitely create drug resistance problems for them long-term. And the combination of PNP and barebacking means they’ll probably wind up poz at which point the drug resistance will be a problem.
Bottom line – if you PNP leave ARVs out of the mix. In the long run you’re better off not taking ARVs until you need them. If you really want to be on PrEP – see a doctor and do exactly what s/he tells you to do (and be honest with them about your recreational drug use)…
I want my MTV too – the old one that played music videos all day long…
What you don’t know about ARVs could fill a book. What is a “mild” ARV? They are all very powerful. Yes some have less side effects but they all prevent replication in different ways.
You cannot gain resistance to an ARV unless you actually have HIV. Resistance happens when the HIV virus mutates to a form that the meds can’t control.
As for starting treatment early, there are many new studies that show once someone acquires HIV, the body creates an imflamatory response that can lead to early cardiovascular problems, cognitive problems and certain cancers. These studies show that once this response is reduced with a lower viral load, disease is reduced and people live a longer life.
I firmly believe that reducing your viral load and controlling the virus sooner than later is best.
Hi RawTOP, if I can also add the following. I used to work at a pharmaceutical company and asked an HIV researcher her thoughts about PrEP. The problem with tenofovir or any HIV/AIDS drug is the toxicity factor. All antiretrovirals are toxic in one way or another. We accept their toxicities because HIV/AIDS is a fatal disease without them. Tenofovir has kidney and bone toxicities. Another problem with HIV is that a single mutation that renders the virus resistant to tenofovir causes resistance to a multitude of other antiretrovirals so PrEP may not even help. Just my two cents…
I have HIV and take Atripla which has tenofivir. Yes it CAN be toxic to the kidneys and linked to bone density problems,but it is a small percentage of people this affects. Retroviral meds are much less toxic than the days of AZT and recommendations for when to start treatment has gone from a Vl of 200 to 350. Many predict it will be 500 within a year or two. My doc recommended me starting when I was 511. My viral load went to undetectable from 47000 in 6 weeks. He’s confident I will stay resistant and be successful with this treatment for many years if not indefinitely. Resistance usually occurs when someone isn’t adherent. I am 100% adherent.
This is not an endorsement of PrEP, but even tylenol or ibuprofen taken every day have very high toxicity to the cardio system and kidneys.
As a very healthy HIV poz man (with great insurance by the way) I had no reservations starting when I did with the encouragement of my doc. I plan to live to 90
I am an educated informed person who takes my health very seriously. I dont fallow my doctors advice blindly. Besides my own ID doc, I’ve read vociferously about best practice treatment. You’re basing your “expertise” on your antecdotal experience with seizures? You may not have had a seizure condition, but I have HIV and medicine has been remarkable in making it a treatable chronic condition. The fact is, today”s drugs are much more tolerable and earlier treatment is recomended.
My God I’m arguing about HIV with a bareback blogger….argh
A couple of things to consider… first, yes, it’s true that you need HIV for it to develop resistance. Thing is, if you’re taking a single Tenofivir along with your tina and Viagra, you’re probably not maintaining a high enough concentration of the drug for it to do any good, should you get infected during the course of your play. You’re only giving HIV a peek at it so that it can more easily adapt and mutate around the drug; that’s the textbook example of how to make a resistant strain. Not to mention that it’s only one drug, not a combo, and we already tried monotherapy in the late 80s/early 90s. You might recall it didn’t work out so well.
On the flip side, I think there is plenty of evidence now that immediate treatment can be good for the long term survival of the patient, if s/he learns about the infection right away. The virus devastates the immune system in the gut, no matter how the transmission occurred, in the first several weeks. There’s an argument circulating now in treatment circles that hitting hard with an early regimen in this period might both limit the damage to the immune system and weaken the virus long term, even if the regimen is not maintained long term but only for the first, say, six months. The trick, of course, is knowing that early that one has been infected, getting the really expensive tests when one has the “fuck flu” and making that very quick decision on the spur of the moment; if one waits then the benefits of immediate treatment are lost.
At least, as far as we understand things now. While we’ve learned an incredible amount over the last three decades about the way the immune system functions, there’s still clearly a lot we don’t know. In any case, I think that fucking around with ARVs that one doesn’t understand, and mixing them with party drugs, is probably a recipe for disaster.
What’s funny about this is that you argue about like you can’t prevent it. If you take personal responsibility and care for yourself, then you can avoid all of that medical nonsense, but as you said before, you’re a bit too selfish for that.
I don’t really care how many people you sleep with recklessly and if you get HIV or not (I’m pretty sure with the way you are, you have it and are in denial, or just straight up lying). But don’t go blaming Medical Professionals when they can’t cure you from something you brought apon yourself.
“That said, it’s true I’m hardly an expert on HIV.”
And yet, still you pose as one, recommending to hold out on treatment (when there is statistical evidence to the contrary) and fantasizing about “mild ARVs” (which is more of an anecdotal observation: What one guy can take for 30 years, might cause kidney problems in another guy after 3 months). Sorry, if I come off as harsh, but what you do is you take your OPINION and present it as a GENERAL TRUTH.
The truth is: There are many terrible doctors out there (what makes a great doctor is the ability to find the right regimen for the specific patient that combines maximum effect with minimum side effects), but that doesn’t automatically make half-informed laymen right.
That’s the only problem I have with posts like these. Love the other parts of the blog, so you really should stick to the joy of barebacking.
Discussions like this are one of the reasons why I’m a safer-sex Nazi. I found this blog at a crucial time. I didn’t bareback often (never bare-bottomed at all), but this blog put an end to any interest I may have had in bareback activity. It also extinguished any interst I may have had in hanging out at the local bathhouse.
A half-hour (or less) of sex (quite possibly lousy sex at that) is not an adequate trade-off for totally overhauling my life. Even if it was great sex all night, it wouldn’t be worth it.
The current indifference to the risk of HIV extends far beyond people who spend a couple of nights a week in bathhouses and hooking up with anonymous people. The lack of current education, misinformation on the topic, and the promotion of bareback practices on porn sites, etc have many people indifferent to HIV–they consider it to be “no big deal”. I don’t consider anything that’s permanently life-altering to be no big deal.
Well Adam, there’s a big difference between getting a cold and having HIV, unless you have a cold while having HIV. These people know what they’re doing, and brought it apon themselves not to care about public health factors at all either.
The Logic isn’t the same either, because one lasts a day or two and you can’t die from it, and one is the complete opposite. That would be like trying to compare an armed bank robbery to a shop lifting, and then you get angry when research hasn’t come up with a cure and only medicines that aren’t yet effective, when you could of completely avoided it in the first place.
“Your “statistical evidence” does not include long range studies of drug toxicity.”
There are statistical indications that guys who start therapy earlier on average survive longer. Drug toxicity is a fact but a.) if you are purely looking at life expectancy that is already factored in and b.) it has to be weighed against complications from an immune system that is already heavily damaged by HIV because therapy started late.
Fact is: I don’t know the absolute truth and probably there is no timeframe that fits every patient, in fact I believe there is a significant number (but not a majority) of patients that benefits from starting late. But that is a question that science has to answer and whose outcome specialists (i.e. doctors, preferably good ones) have to implement.
My criticism is directed at your comparing apples with oranges. Believe me, you are not the only neg guy that is supposed to take tremendously toxic medications. But taking a certain medication “for the rest of your life” doesn’t mean the same thing, it can be prophylactically or to fight a progressive diseases like HIV/AIDS. Totally different thing. Your personal experience with a completely unrelated drug doesn’t translate into a general truth about HIV. Not a single bit.
Being able to compare and generalize is a sign of human intelligence – it’s what sets us apart from apes. But not all generalizations are valid.
rawTOP, I disagree with your post and responses. I am HIV+ and pass no judgement on individual behaviour. I am approaching this from a purely medical and logical perspective. The main point I would like to make is that if you think, “prevailing medical theories are hazardous to your long-term health”, you must provide generally applicable, verifiable, and systemic evidence to such a significant conclusion.
Firstly, I would like to address your argument that doctors endorse early HAART because they want to minimize the risk of HIV transmission. In this assertion, you do not satisfy a burden of proof aside from your personal beliefs. This issue of logical reasoning aside, the medical community has conducted dozens of objective and rigorous trials that have concluded that commencing HAART before the CD4 count, an important marker of immune system health, falls below 300 can lead to better immune reconstitution. In essence, by starting HAART when your CD4 count is lower, you will have less improvement in your immune system. If you search “early HIV treatment” on Google, these studies are readily available. A stronger immune system means less viability of opportunistic infections and other complications.
You are right that ARVs have strong side effects, and this is not to be ignored. Indeed, the treatment of HIV in the HAART era is less about HIV and more about effective management of ARVs. It is integral to create a HAART regimen with a minimal side effect profile. That said, it is evidently clear that a suppressed immune system is a far significantly threat to your health than effectively managed side effects, even if we are not fully aware of their long-term ramifications. The medium-term ramification of a suppressed immune system is well known, it is death. If an ARV causes severe medically threatening side effects, then a competent doctor would discontinue the drug. I would also stress the critical difference between a side effect that causes discomfort but is not medically threatening, and one that is a threat to health.
There is other research, some refers to the early effects HIV may have on the body, to further support the early use of HAART. There are also those in the medical community who disagree with the early adoption of HAART, and it is usually from a quality of life point of view. This is a reasonable and relevant objection insofar as the early adoption of HAART does not have overwhelming consensus. My point is that doctors do not place patients on HAART in the community interest, but rather in agreement with the majority of the medical community, that early HAART is more effective to manage HIV in the long-term. To suggest otherwise, without evidence, is a logically weak conclusion.
I would also note that what is relevant here is not the time of diagnosis, but rather, the time of infection. If it has been 1 year or more (and sometimes less) since seroconversion, the CD4 count can fall below 250. There is overwhelming consensus in the medical community that HAART should commence then. Based on my sexual history, I knew I seroconverted 2 years prior to my diagnosis and my CD4 count had already fallen below 250. Accordingly, any doctor should endorse HAART if the CD4 count is below 250.
Secondly, I would like to address your argument about following not following doctors’ advice because they are concerned about their liability or other issues contrary to the patient’s interests. I believe what you are referring to when speaking of the “white coat effect” is the Milgram experiment in the 1960s at Yale University and associated studies. I would note these were not about following instructions from doctors specifically, but rather authority figures at large. The term the “white coat effect” actually refers to the issue of discordant blood pressure readings between measurements at the doctor’s office and when at home because of stress, so I am unsure where you read about that.
In any case, your evidence that doctors behave in the manner you describe is primarily from a personal example. To conclude that this is then the case for the majority of doctors is a faulty generalization and a fallacy of anecdotal evidence. You may be correct that the doctor in your case was incompetent in providing medical advice. This happens and it is regretful. This is why second, third, and fourth opinions are important in medical treatment, alongside personal research. I would note, however, that simply because a medical condition does not have symptoms you could feel, does not mean it is not a problem. Cancer, for example, can remain painless until it is too late for treatment. Regardless, to conclude “the system is fucked up” from your personal example is logically erroneous. “The system” has made living with HIV/AIDS until a near normal life expectancy possible via ARVs. A disease that was once a death sentence became a chronic condition in 20 years. That is reasonably effective.
‘A European would likely have no problem taking meds because it’s in the best interest of the community.’
As a ‘European’ (a white British male to be precise), I have to say I find it pretty offensive that we (by which I mean Europeans – of whom there several hundreds of millions no matter how you actually define Europe) are lumped together and then made subject to sweeping statements on what you, a white American who quite possibly never visited Europe never mind lived here, think ‘our’ outlook on life is.
What next? ‘All blacks have a great sense of rhythm.’ or how about ‘Slitty-eyed chinks can live on a bowl of rice a day.’
Keep on blogging but, please, drop the racist stereotyping!
Again you are comparing apples and oranges: Yes, studies must be read critically and, yes, the commercialization of the US health sector is mindboggling. However, doctors describe overpriced medications not because studies say they are better, but despite the fact that everyone knows they work just the same as the generic version. Today every scientist knows that we use too many antibiotics. It’s not that the science is wrong, it’s just that doctors are often more interested in the commercial side. Also there is university and non-profit (e.g. Bill and Melinda Gates foundation) research. Basically you say that a gut feeling is better than a scientific process (albeit a compromised one). That is reminiscent of the Bush administrations war on science.
And again: Hypertension is not a progressive disease in the same sense that HIV / AIDS is. Untreated, HIV / AIDS wreaks havoc on your remaining immune system, your brain and other organs. The question what 30 years of drugs will do to someone is only really relevant if a cure is only 15 years in the future. But if the choice is a fried liver after 30 years or a nice burial after 25, does it really matter still?
“I’m all for science, but commercially funded and biased studies are not science.”
No disagreement here, my problem is that the only alternative you present is gut instinct and a paranoid world view instead of discussing the value and / or shortcomings of a certain study. Which is ok, you are no research scientist, neither am I, but then you shouldn’t speak from a position of authority.
“There are clear parallels with HIV. Hypertension is a progressive disease.”
Absolutely not in the same way. E.g. in some cases with HIV you have the choice between frying your liver with the medication or have the virus purée your brain. Talk about quality of life.
“The people who took AZT are paying the price for it now because it seriously fucked up their systems.”
And 98% of those who didn’t died (well, most of those who took AZT ONLY also died, albeit later). Such a statement is worthless without discussing the alternatives. And discussing alternatives also means discussing likelyhood. You make it sound like it was 50/50, when every study done everywhere comes to the same conclusion that there are far fewer long-term-nonprogressors.
And we actually do agree on the fact that for SOME people a more conservative approach is best, I said that right from the start. And we do need more genetic testing and monitoring to point out those lucky few. But a lucky few they are.
I’d just like to issue a warning against generalizations based on anecdotal evidence observed from a distance. Many of those guys who looked healthy for 10 years suddenly disappeared, because suddenly dementia set in. You always have to look at the whole picture.
So stick with the joy of barebacking, talk about NY crusing hot spots and young hotties taking raw cock and cum up the ass there.