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AIDS and HIV Information

AIDS and HIV Information

PrEP HIV Pills: What Are They?

PrEP HIV Pills: What Are They?


Since the approval of HIV pre-exposure prophylaxis (PrEP) by US Food and Drug Administration (FDA) in 2012, usage remains low. Large, internet-based surveys of American gay, bisexual, trans-female, and other men who have sex with men (MSM) showed that there was an increase in PrEP awareness from 45% in 2012 to 68% in 2015, but the actual uptake is far lower. PrEP has the potential to reduce new HIV infections, especially among men who have sex with men. But as the study demonstrated, there is a large gap between the number of MSM who are aware of PrEP meds and those who have actually used it.
The same discrepancy has been observed by researchers in Canada. While there was an 18% to 80% increased awareness of PrEP among HIV-negative men and 36% to 77% increase among HIV-positive men, actual usage is only 2%. Uptake of PrEP has sure increased since it was first approved, but it is not enough to make a significant impact on the HIV epidemic.

Pre-exposure prophylaxis

PrEP is a course of antiretroviral drugs for HIV-negative individuals who are at high risk of being infected by the disease. When taken properly and consistently, it is proven to reduce the risk of contracting HIV by over 90% or more among MSM group. There are about 500,000 MSM and 1.2 million adults in the United States who could benefit from PrEP, but only around 80,000 are thought to be taking the regimen. Despite the proven potential benefits of PrEP, patients must not rely on it solely, as there are other effective HIV prevention methods, such as early testing and treatment and safe-sex practices. One should consider PrEP as a complementary tool to significantly reduce HIV infection risk. Another important thing to note is that PrEP meds does not cure HIV nor prevent you from other sexually transmitted diseases like gonorrhea, syphilis, and chlamydia. It also won’t protect you from getting pregnant.

Recommended PrEP HIV pills

Generic Name

Brand Name

Dose

Side Effects

*Emtricitabine (FTC)

Emtriva

200mg once a day

Rash, headache

Tenofovir disoproxil fumarate (TDF)

Viread

300mg once a day

Nausea, flatulence

TDF + FTC

Truvada

300mg/200mg once a day

Nausea, diarrhea


*Not to be used alone.
There may be several antiretroviral agents and drug combinations approved for pre-exposure prophylaxis but Truvada is the only fixed-dose combination regimen recommended by the Department of Health and Human Services (DHSS). Truvada contains two different anti-HIV medications in one pill: emtricitabine and tenofovir disoproxil fumarate. Both drugs belong to the nucleoside reverse transcriptase inhibitor (NRTI) drug class, also known as “nukes.” These potent medications serve as the backbone of different antiretroviral regimens that are used to lower HIV levels in infected individuals. Since the cure for HIV remains elusive, the goal of antiretroviral therapy (ART) is to suppress the levels of HIV RNA in the plasma and maintain the immune system function. Truvada is already being used for this indication but it has to be combined with an integrase strand transfer inhibitor (INSTI) such as dolutegravir or raltegravir. For PrEP, Truvada does not require an additional INSTI, since it is meant for uninfected individuals.

Controversial approval

The approval of Gilead Sciences’ Truvada for HIV prevention has faced backlash and controversies. Some HIV experts believe that healthy, uninfected individuals may not take the drug as directed, which would promote resistance to the medication. Public health officials are also worried that PrEP would encourage risky behavior among patients who are taking the regimen, thinking that they are totally protected from being infected.
TDF is an alternative treatment to Truvada, but only for injection drug users and heterosexually active adults. The new tenofovir prodrug, tenofovir alafenamide (TAF) should not be used to replace TDF or as an addition to the regimen. Patients must take the drug as directed, around the same time each day to ensure adequate drug levels in the blood. Do not take PrEP intermittently; you will not be protected if you take PrEP after you have been exposed. If you need emergency treatment following an accidental exposure, inquire about PEP instead.

How long does it take for you to be protected?

Data from pharmacokinetic studies in HIV-negative men and women suggest that the maximum concentration of tenofovir diphosphate (the active form of TDF) in the blood is reached after 20 days of daily oral dosing. In contrast, it takes seven days for rectal tissues, and 20 days for cervicovaginal tissues. All patients taking PrEP should schedule a follow up:

Every three months

  • To be tested for HIV status and check for signs and symptoms of acute infection
  • To refill their prescription of daily Truvada for nor more than 90 days
  • To be tested for other sexually transmitted diseases if they are sexually active
  • To be tested for possible pregnancy

Every six months

  • To have their kidney function assessed by monitoring their creatinine clearance
  • To be tested for sexually transmitted diseases even if asymptomatic

Every 12 months

  • To know if continuing therapy is necessary to prevent HIV infection

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