PrEP: Protection against HIV in a pill?
HIV (human immunodeficiency virus) weakens the human immune system and destroys important cells that fight disease and infection. A person may be exposed to HIV when body fluids - including blood, semen, pre-seminal fluid, rectal fluid, or a person's vaginal discharge with the virus - come into contact with mucous membranes or damaged tissue. HIV can be transmitted through breast milk, or when contaminated needles or syringes are in direct contact with the bloodstream.
There is no cure for HIV, but with proper medical care, the virus and its effects can be controlled. HIV transmission can be reduced by consistently using condoms and clean needles. However, another way to protect against HIV is pre-exposure prophylaxis, or PrEP. PrEP: Protection against HIV in a pill?
PrEP is a pill that can help prevent HIV
PrEP is a combination of two antiretroviral drugs, tenofovir and emtricitabine, which, if taken daily, can now prevent HIV. Pills (Truvada) are FDA approved. Truvada works by blocking the enzymes so that HIV can not reproduce and form infections in the body. PrEP: Protection against HIV in a pill?
These pills are taken with or without food. It would be better if taken at the same time each day, as this helps shape the routine. Skipping days is not recommended. If you forget the dosage, take it as soon as you remember. If it's almost time to take the next dose, skip the missed dose and continue the routine dosing schedule. Truvada has a full seven to 20 days after starting treatment. This can be stopped whenever the protection it offers is unnecessary (for example, if your risk for HIV or preference changes). Talk to your doctor when stopping or starting any medication. PrEP: Protection against HIV in a pill?
Who should consider PrEP?
The following circumstances mean that PrEP may be a good option and should be discussed with your doctor:
- if you have ever done anal or vaginal sex with more than one partner and prefer to use condoms only occasionally or not at all
- if you are a sexually active adult male who prefers male partners, whose HIV status may be unknown
- if you are in a relationship with an HIV-positive partner
- if you recently have in the anus or vagina
- if you have had sex with someone who injects drugs, if you've been using stimulants, poppers, cocaine, meth, ecstasy, or speed in the last six months. PrEP: Protection against HIV in a pill?
What about condoms?
Condoms do provide protection against HIV. Unlike PrEP, they also protect against other sexually transmitted infections, and prevent pregnancy when used correctly and consistently.
Does PrEP have side effects? Overall PrEP is well tolerated. As well as starting treatment, some people will experience side effects such as nausea, gas, or headaches. In general, these side effects are mild and tend to improve over time if the drug is stopped. Kidney problems can occur rarely, so doctors will monitor your kidney function with routine blood tests. Some people may experience a mild reduction in bone mineral density. The importance of this is unknown, but it tends to be stable or back to normal over time.
PrEP does not interfere with most drugs including suboxone, methadone, or oral contraceptives, and does not affect sexual performance. Although this drug has been widely used in pregnant and lactating women who have HIV infection, the risks / benefits of using it for HIV prevention during pregnancy or breastfeeding need to be done individually. Talk to your doctor if you are taking NSAIDs such as ibuprofen or naproxen, or antivirals such as valacyclovir or acyclovir.
What's next step if you think PrPP is right for you?
Make an appointment with your doctor and talk about why you think you want to take this medicine. Your doctor will run tests to check for HIV and other sexually transmitted infections as well as hepatitis A, B, and C, and check your kidney function before starting PrEP. Usually your provider will need to get prior authorization for treatment. Most insurers cover the cost. If your provider is uncomfortable prescribing this medicine, ask to be referred to an HIV specialist in your area.
You will need to see your doctor initially after one month and then every three months, when the HIV test and sexually transmitted infections will be restarted. Your kidney health will be monitored through blood tests once in six months, and PrEP should be stopped if the kidneys are affected.
Centers for Disease Control and Prevention, HIV Basis: About HIV .
Centers for Disease Control and Prevention, HIV Basics: PrEP .
US Public Health Service, Preexposure Prophylaxis for Prevention of HIV Infection in the United States - 2014: Clinical Practice Guideline (PDF).
Acknowledgments: Dr. Linda Shipton, MD, a specialist in internal medicine and infection at the Cambridge Health Alliance, for support during the preparation of this post. PrEP: Protection against HIV in a pill?
PrEP: Protection against HIV in a pill?