How PrEP’ed Are You?
We know people have a lot of questions and concerns around PrEP, so we sourced some answers for you. What is PrEP? PrEP: Short for “pre-exposure prophylaxis,” PrEP is an HIV prevention strategy in which HIV-negative people take an oral pill once a day before coming into contact with HIV to reduce their risk of HIV infection. What does it do? Truvada for PrEP works by blocking an enzyme called HIV reverse transcriptase. By blocking this enzyme, it prevents HIV from making more copies of itself in the body. Without the ability to replicate, the virus is unable to take hold and is cleared from the body. It’s important to remember, though, that PrEP may not be 100% effective in preventing HIV. Adherence:
- For HIV-negative people, not taking PrEP daily can lead to increased risk for HIV infection.
- It’s important PrEP is taken consistently and correctly to minimize the chances of becoming infected and subsequently developing resistance to Truvada.
- According to experts PrEP must be taken for at least 7 days to reach optimal levels of protection against HIV.
- It’s recommended that all men who have sex with men, including those taking PrEP, get screened for STIs every three to six months.
What are the side effects from Truvada for PrEP?
- Truvada is a safe and well-tolerated drug.
- About 1 in 10 people in PrEP studies reported they had nausea, stomach pain, or weight loss when they first started taking Truvada. (In most people, these side effects went away after a few weeks.)
- A small number of people had a decrease in kidney function (that returned to normal when they stopped taking PrEP).
- It is important to have regular blood tests to monitor your kidney function while taking PrEP.
- Small losses of bone density (thickness) have also been seen in people taking Truvada;
If I start PrEP, can I stop using condoms? The important thing is to find an HIV prevention strategy that fits yours needs and meets your sexual health goals.
- The choice to use condoms, like the choice to use PrEP, is a personal decision.
- For people who do not use condoms every time they have sex, PrEP can provide an effective layer of protection against HIV.
- Condoms have been and continue to be an effective tool in reducing HIV risk.
- Using condoms correctly and consistently while taking PrEP will provide the maximal protection against HIV and STIs.
In the iPrEx study of gay/bi men and transgender women, PrEP was found to reduce almost half of HIV infections overall, and among those who took PrEP consistently and had Truvada detected in their blood, it is estimated that PrEP was over 90% effective in preventing HIV infections.
iPrEx (also known as the Chemoprophylaxis for HIV Prevention in Men trial or the PrEP Initiative) was the first study to report data on the effectiveness of oral PrEP, the use of a pill usually used to treat HIV infection to reduce HIV infection risk, in people. The initial iPrEx results were reported in November of 2010 in the New England Journal of Medicine. iPrEx found that daily use of the antiretroviral drugs combination emtricitabine 200 mg. and tenofovir 300 mg. (FTC/TDF), also known as Truvada®, provides 99% protection against HIV infection in MSM, when taken seven days a week. iPrEx was a double blind placebo controlled trial, meaning that half of the study participants received Truvada and half received a placebo (blank pill). Neither the study participants nor the investigators knew which participants received the drug or the placebo.
Won’t people start having “riskier sex” when they begin taking PrEP? If more and more people start using PrEP, won’t the rate of STIs go up? Concerns have been raised that the use of PrEP will lead to increases in sexual risk taking (risk compensation). In the iPrEx study, participants who believed they were taking Truvada for PrEP did not increase their sexual risk behavior, and rates of syphilis infection went down. *** *** It’s important to note that during the study, participants didn’t know whether Truvada as PrEP was effective in preventing HIV or whether they were getting Truvada or a placebo (dummy) pill. PrEP demonstration projects are currently underway to evaluate whether sexual behaviors change in people taking PrEP in the “real-world,” and will also help determine how to best deliver PrEP in different settings. If my HIV-positive partner has an undetectable viral load and I’m HIV-negative on PrEP, can I stop using condoms? Your partner being undetectable significantly reduces your risk for HIV (assuming there are no other sexl partners in your relationship and you and your partner do not have a sexually transmitted infection). Remember: Being undetectable or taking PrEP does not protect you against STIs like gonorrhea or syphilis, or prevent pregnancy. Condoms further reduce your HIV risk as well as your risk for other STIs. If you stop taking PrEP for more than seven days and want to restart taking PrEP, it’s important to see your provider and get an HIV test before restarting PrEP to minimize the risk of developing drug resistance. It is important to see your provider and have testing done to make sure you are HIV-negative before you start using this HIV prevention strategy, and to be re-tested before re-starting PrEP if you’ve been only taking PrEP off and on. It’s also important to take PrEP consistently and correctly to minimize the chances of becoming infected and subsequently developing resistance to Truvada. What if I decide that I don’t want to take PrEP anymore? How can I stop it safely? We recognize PrEP is not meant to be taken for the rest of your life. If you decide PrEP is no longer a useful HIV prevention strategy for you, we recommend you discuss this with your medical provider before stopping PrEP. It is helpful to discuss how your sexual behaviors or relationships may have changed, and also the last time you had sex. You may be advised to continue taking PrEP for four weeks after your last potential exposure to HIV, as this is the recommendation for post-exposure prophylaxis (PEP), where individuals take anti-HIV medications for 28 days after a significant HIV exposure. Can I potentially expose my next HIV-negative partner to the virus from the previous HIV-positive partner? You cannot serve as a type of “pass-through,” where you carry HIV from one partner to another while staying uninfected yourself. However, if you were to become HIV infected while on PrEP (either because you weren’t taking it consistently, or if PrEP were not 100% protective), then you could potentially pass HIV on to HIV-negative partners. Getting tested regularly for HIV is an important part of taking PrEP to ensure that you remain HIV-negative, and as described above, to minimize the risk of developing HIV resistance if you become infected. If an HIV-negative person taking PrEP has condomless sex with an HIV-positive person who doesn’t have an undetectable viral load, where does the virus go? Am I protected by PrEP if my HIV-positive partner is resistant to Truvada? As Truvada contains two medications (emtricitabine and tenofovir), it is important to consider whether your HIV-positive partner has resistance to one or both medications in Truvada. In animal studies, Truvada was effective in preventing infections with a virus that was resistant to emtricitabine alone. However, there was reduced protection with Truvada PrEP in cases of tenofovir resistance. Fortunately, resistance to tenofovir is still relatively uncommon in the community. As we don’t know whether results seen in monkey studies will apply to people, additional studies in humans are needed to address this important question. Things to Keep in Mind
- Only people who are HIV negative should use PrEP or PEP.
- You must be tested for HIV and have a documented negative test result before starting PrEP.
- PrEP and PEP are available by prescription from a medical provider, such as a physician, nurse practitioner, or physician assistant. You can also get PEP at your local emergency room or urgent care clinic, although these locations may provide just the first two or three days’ doses to get you started (for example, until your medical provider’s office reopens on a weekday). You will need to talk with your provider to see if PrEP or PEP is right for you.
- PrEP is more than just taking a pill every day; it also involves frequent medical visits and lab tests to check for HIV, other STIs, and any changes in kidney health.
- Neither PrEP nor PEP protects against other STIs or pregnancy, and they are not cures for HIV.
- PEP is taken for 28 days.
- PrEP does not have to be taken forever and can be stopped at any time under the supervision of your medical provider. When stopping PrEP, individuals should continue using it for four weeks after the last significant exposure.
There are now a variety of ways that you can choose to stay safe when having sex. Choosing a strategy that suits you and your personal circumstance is crucial. Whether you choose to use condoms, take PrEP or rely on treatment as prevention, it is important that your choice is an informed one. PrEP is recommended for people who are at high risk of acquiring HIV. Clinical guidelines stipulate that PrEP should be prescribed to HIV negative people who are at an ongoing risk of acquiring HIV. These people might be gay or other same-sex attracted men who do not always use condoms with casual partners when having anal sex. In NSW, you can find out more about how to access PrEP through the EPIC-NSW Study here. You must be HIV negative and an HIV test should always be performed before you start taking PrEP. Book a HIV test at a[TEST] here. References  Prep-Burning Questions Answered by Dr. Albert Liu. Retrieved from https://betablog.org/prep-burning-questions-answered/ on the 26-1-2017  What is the iPrEx study? Retrieved from https://www.iprexole.com/1pages/prep/prep-whatistheiprexstudy.php on the 26-1-2017  Fact Sheet: PrEP and PEP published on the March 3, 2014, by Emily Newman. Retrieved from https://betablog.org/fact-sheet-prep-pep/ on the 26-1-2017  Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men – – N Engl J Med 2010; 363:2587-2599 published December 30, 2010 retreved from https://www.nejm.org/doi/full/10.1056/NEJMoa1011205 on the 26-1-2017 Methodology: The study subjects were followed for 3324 person-years (median, 1.2 years; maximum, 2.8 years). Of these subjects, 10 were found to have been infected with HIV at enrollment, and 100 became infected during follow-up (36 in the FTC–TDF group and 64 in the placebo group), indicating a 44% reduction in the incidence of HIV (95% confidence interval, 15 to 63; P=0.005). In the FTC–TDF group, the study drug was detected in 22 of 43 of seronegative subjects (51%) and in 3 of 34 HIV-infected subjects (9%) (P<0.001). Nausea was reported more frequently during the first 4 weeks in the FTC–TDF group than in the placebo group (P<0.001). The two groups had similar rates of serious adverse events (P=0.57).