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If you are HIV-negative and engage in activities that put you at high risk for HIV or would like to further protect yourself in case of a broken condom, then PrEP may be an
option for you. This article describes what PrEP is and some of the issues that goes along with taking this daily pill.

A few quick facts about PrEP ...

• PrEP (Pre-Exposure Prophylaxis) is a single pill called Truvada taken once a day to prevent HIV infection in people who are at high risk for it.
• Taking PrEP does not mean that you’re 100% protected from getting HIV.
• PrEP is used along with other prevention methods, such as condoms.
• Taking PrEP must be done with the support of a health care provider.
• Some doctors may not know aboutPrEP or may not be willing to discuss it or your sexual activities with you.
• Taking PrEP includes getting routine
blood tests and seeing your doctor more often.
• You may have side effects from taking PrEP.

What is PrEP?

In July 2012, the US Food and Drug Administration approved Truvada for PrEP for adults at high risk for sexual transmission of HIV. Two clinical studies show that HIV-negative people who take Truvada for PrEP every day (or nearly every day) and who combine it with condoms (and other HIV prevention methods) may see their HIV risk cut by up to 90%. This is true in both women and men and for both vaginal and anal sex.

If you take PrEP, you’ll also need to see your doctor at least every three months for routine care and testing. You’ll need to talk about your current sexual activity, your level of risk, STDs, routine test results and any side effects. This means more doctor visits, refills, co-pays, and extra attention to your HIV prevention plan.

How does Truvada work?

Truvada is a pill made up of two HIV meds — Viread and Emtriva. Truvada prevents HIV from reproducing in the body. If you are exposed to the semen, pre-cum or vaginal fluids from an HIV-positive person, then Truvada can help to keep the virus from causing a lasting infection.

How well does Truvada prevent HIV?

In two large clinical studies, when people took Truvada as close to every day as possible, the pill appeared to lower their risk for infection by at least 90%. It did not protect people as well who took it less often. As with any medicine, it can’t work if you don’t take it.

What are Truvada’s side effects?

The short-term side effects from the PrEP studies included headaches, weight loss and stomach problems like nausea, diarrhea and gut pain. Some people also had slightly poorer bone and kidney health, which got better when Truvada was stopped. As for Truvada’s long-term side effects, we don’t yet know about them since these PrEP studies only followed HIV-negative people up to two years.

Why should you take PrEP every day?

The PrEP studies so far clearly show that people who take Truvada every day have a much lower risk of HIV infection. Not taking PrEP as prescribed can increase your risk for getting HIV. Therefore, it’s very important that you take PrEP as directed or as close to it as possible. Some newer information shows that a missed pill every now and then may still protect you, however.

When do you start and stop PrEP?

It depends. Generally speaking, people should use PrEP over a period of time when they are at a high risk for getting HIV. Some people will only need to use PrEP for a short time because they quickly adopt safer behaviors. Others may find the need to take it over years. Still others may want to start for awhile, stop for some time, and then re-start for another period. Making these decisions should be done with help from your doctor.

What if you get HIV while taking PrEP?

In this case, you should notify your doctor immediately, unless he already knows because they did the HIV test. You will stop taking Truvada and assess when to start a full HIV regimen. Because Truvada is not a full HIV regimen, there’s some chance that resistance could develop, which means you may not be able to use Truvada later in the full HIV regimen.

What tests will you need to get?

Before you start PrEP, the following tests and exams should be done by your doctor:

• A thorough and honest talk about your sexual activity and level of HIV risk.
• An HIV antibody test and maybe a test to detect HIV directly to make sure you’re HIV-negative.
• Tests for STDs, kidney function and hepatitis B. (It’s important to know if you have hep B because the drugs in Truvada also treat hep B and could harm the liver if misused.)

While you’re taking PrEP, the following should be done:

• Regular doctor visits every 2 to 3 months.
• Routine HIV tests (at least every 3 months) to make sure you continue to be HIV-negative.
• Someone in your doctor’s office should talk to you about side effects, adherence and risky activity.
• STD tests at least every 6 months.

Do you still have to use condoms?

In an ideal world, everyone would use condoms and other risk-reduction behaviors to prevent getting HIV. This is not always possible. Your partner(s) might refuse to use them. If you are depressed or using alcohol or drugs heavily, condoms may seem impossible. You and your partner may see using them as a sign that you don’t trust one another or love each other less. Plenty of people struggle with condom use, so you shouldn’t feel ashamed if you have trouble with this.

With that said, however, the FDA approved Truvada for PrEP along with using condoms and other prevention methods. PrEP is not 100% effective on its own, and in clinical studies people used condoms with PrEP. In the best-case scenario people would use condoms as much as possible while taking PrEP. Anyone being prescribed PrEP can get free condoms through Gilead, the company who makes Truvada.

Where do you get PrEP?

For people whose insurance covers PrEP, the major cost should only be the drug co-pay and co-pays for doctor visits and lab tests. Gilead will cover the drug co-pays (888-358-0398).

For people without insurance, or whose insurance won’t cover PrEP, Gilead will help those with lower incomes. To learn more about this program, go online at https://start.truvada.com/.

What else is there to know?

Project Inform has a longer, more in-depth publication for both patients and providers, available at http://www.projectinform.org/prep/. Other informational websites include: https://start.truvada.com/,
and http://myprepexperience.blogspot.com.

Copyright 2018, Positive Health Publications, Inc.

This magazine is intended to enhance your relationship with your doctor - not replace it! Medical treatments and products should always be discussed with a licensed physician who has experience treating HIV and AIDS!