What is PrEP?

PrEP (pre-exposure prophylaxis) involves taking a pill every day to prevent HIV. There are currently two medications approved for use as PrEP: Descovy and Truvada. They are both HIV medications that work by blocking an enzyme called reverse transcriptase, which the virus uses to make more copies of itself. When HIV is unable to make copies to infect more cells, the body’s immune system is able to clear it so the person doesn’t become infected if they get exposed. Both drugs are equally effective at preventing HIV in cisgender men and trans women.

Descovy and Truvada both contain the ingredients tenofovir and emtracitabine. The tenofovir in Descovy is a newer form that is effective at lower doses and has less risk of kidney or bone damage when taken for many years. Descovy was just approved for use as PrEP in 2019, and it isn’t approved yet to prevent HIV for people who are at risk because they inject drugs or for people who have receptive vaginal sex. If you have vaginal sex with men, or are interested in PrEP to decrease the risk from injection drug use, Truvada is the best option.

How well does it work?

PrEP is very effective at reducing the risk of getting HIV. The estimated level of protection is 99% for people who take 7 pills per week. PrEP is fully effective to reduce the risk of HIV from receptive anal sex after 7 days, but it takes 21 days to reach the full risk reduction for receptive vaginal sex.

Who should use PrEP?

PrEP might be right for you if you are an adult without HIV infection and don’t always use condoms with partners whose HIV status is unknown, have had another STI in the past 6 months, have sex with both men and women, have sex with people who might be at an increased risk of HIV because they inject drugs or are men who have sex with men, if you inject drugs, or if you are in a relationship with an HIV-positive partner.

If you think you were recently exposed to HIV, you may need PEP (post-exposure prophylaxis) which is different from PrEP. PEP should be started as soon as possible after an exposure to HIV, within 72 hours, so schedule an appointment right away to discuss your risk if you think you had an exposure and are not on PrEP.

What are the down sides of PrEP?

PrEP does not reduce the risk of gonorrhea, syphilis, chlamydia, or other infections. Reducing how many sexual partners you have and using condoms is still recommended for people taking PrEP to reduce the risk of other STIs (and unintended pregancy). Having an STI such as gonorrhea makes a person 5 times more likely to get HIV because these infections disrupt the body’s normal defense of preventing bacteria and viruses from passing through the skin and mucus membranes. Preventing STIs and diagnosing and treating them early if they occur is important to reduce the risk of HIV transmission.

Most people do not have any problems while taking PrEP, but some people have side effects such as nausea or loss of appetite. There can also be long-term side effects, such as decreased kidney function and decreased bone density in people taking Truvada.

I’m interested. What’s the next step?

Schedule an appointment to discuss starting PrEP. During the initial visit, your provider will:

  • Discuss your risk of sexually transmitted infections including HIV and strategies to reduce your risk, including PrEP.
  • Review your medical history to determine if PrEP is likely a safe option for you.
  • Order labs including tests for hepatitis B and HIV, and check your kidney function.

After getting started on PrEP, you will need to repeat screening for STIs every 3 months. This is both to make sure that you remain HIV negative, and so if you do get an infection like gonorrhea or chlamydia, we catch it early and get you treated so it doesn’t increase your risk of getting HIV. At each follow up appointment, your prescription will be refilled for another 3 months.

Is it expensive?

Most insurance plans cover PrEP. Call your health insurance provider to find out if you will have any costs to get PrEP. There are many programs available to help with coinsurance and copays, and programs to help people without prescription coverage get PrEP for free.

A generic version of Truvada will be available starting September 30, 2020, which will be covered by most insurance plans with $0 out-of-pocket cost. Read this POZ article for more info.

Where can I find more information about PrEP?

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