What is PrEP and How it Can Prevent HIV?
- PrEP refers to Pre-exposure prophylaxis or the use of antiretroviral medications to prevent uninfected people from being infected by HIV.
- Anti-HIV drugs in PrEP are approved by the US FDA and are proven safe and effective.
- A once-a-day dosing is recommended for PrEP to work.
- In 2015, the World Health Organization recommends that people who are at high risk of being infected must be offered PrEP as an additional prevention choice.
- PrEP is not a vaccine.
- PrEP won’t protect you from other sexually transmitted diseases, such as gonorrhea, herpes, and hepatitis C.
- You still need to practice safe sex (i.e., wearing condoms) while on PrEP.
- PrEP is only taken for short periods and not for life.
- Truvada (emtricitabine/tenofovir) is the only approved antiretroviral medication for PrEP use.
- A 2015 survey revealed that 34% primary care providers had never heard of PrEP.
Pre-exposure prophylaxis or PrEP is a preventative measure where antiretroviral medications are given to very high-risk HIV-negative individuals to prevent them from acquiring the disease. These people will have lower chances of being infected if they take these medications daily. PrEP can significantly reduce your risk getting the virus from sex by more than 90% and from injecting drugs by 70%. Antiretroviral medication used for PrEP are found to be effective in men who have sex with men (MSM), heterosexual men and women, and injection drug users. It is even more effective when combined with other ways to prevent infection, including drug abuse treatment, condom use, and treating people with HIV to minimize transmission. Primary care doctors must be able to deliver PrEP care by testing for HIV, inquiring about sex and drug abuse behavior to determine risk of getting HIV, and prescribing PrEP drugs when needed.
How can a daily pill prevent HIV?
Truvada is the drug of choice for pre-exposure prophylaxis. The pill contains two HIV medications, emtricitabine and tenofovir disoproxil fumarate, that are inadequate for HIV-infection treatment but are proven safe and effective when used as prophylaxis. PrEP aims to prevent HIV infection from taking hold should you get exposed to the virus. Emtricitabine and tenofovir work by blocking important steps in HIV’s life cycle. It’s important to take the pill every day because adequate levels of the two drugs in the bloodstream is necessary to stop the virus from establishing itself and multiplying in your body. If you fail to take a dose of Truvada, there may not be enough medicine in your blood to block HIV.
Is PrEP Safe?
As with all medications, there are adverse effects associated with Truvada use. The effects of the drug may differ from patient to patient. Some may experience minor side effects that resolve over time. If you have persistent signs and symptoms while on PrEP, call your healthcare provider right away. Side effects reported during trials include upset stomach, headache, vomiting, and loss of appetite. Inform your doctor if you are experiencing unusual side effects such as fever or chills, sore throat, cough, rash, and other signs of infection.
Who Should Take PrEP?
PrEP does not work for those who are already infected by the virus. While you can still take Truvada if you are HIV-positive, you need to take additional HIV drugs to suppress the virus. Your doctor may suggest that you take PrEP if:
- You are a man or woman who:
- has an HIV positive sexual partner;
- has multiple partners or a partner with multiple partners;
- Who doesn’t know your partner’s HIV status;
- Who doesn’t often use condom while having sex.
- You inject drugs and:
- Share needles or paraphernalia to inject drugs;
- Recently underwent a drug rehabilitation program;
- Are at risk for acquiring HIV.
How effective is Truvada as PrEP?
There is evidence that taking daily PrEP reduced the risk of getting HIV infection. Truvada is the only approved oral medication for this indication. The randomized, double-blind iPrEx study was the first study to have demonstrated the effectiveness of PrEP. Almost 2,500 HIV-negative MSM in the United States, South America, Thailand, and South Africa were given once-daily oral Truvada or placebo. Those who received Truvada had a 44% reduction in HIV risk. Among heterosexual couples in which one partner had HIV infection, those who received PrEP were 75% less likely to acquire the disease than those who took the placebo. Those who were more consistent in taking their pills reduced their risk by up to 90%.