In my private practice, one of the most common topics I discuss with patients is PrEP which stands for pre-exposure prophylaxis. I want to take this opportunity to briefly discuss PrEP with some common questions, and why I feel it’s such an amazing tool in the prevention of HIV infection.

What is PrEP?

PrEP is a medication based strategy to help HIV negative individuals prevent HIV infection. It involves the use of antiretroviral medicines to help reduce the risk of contracting HIV from an HIV positive partner. Currently, Truvada is the only FDA approved drug for use as PrEP and is a combination of the drugs tenofovir disoproxil fumarate and emtricitabine. Studies have shown that a single pill is taken consistently and daily can help reduce the risk of transmission of HIV by greater than 90%. The medication works very well to prevent HIV transmission, but it must be taken consistently to reach adequate levels in the blood and tissues to be most effective. About 7 days of consistent use is needed for maximum protection during receptive anal intercourse and about 21 days for receptive vaginal intercourse.

Is PrEP right for me?

PrEP is one of many options for helping to prevent HIV infection. When we think about who may benefit most from its use, providers tend to think about this from a lens of risk factors. Thus, we would think a patient who has more risk factors is likely to benefit more from PrEP than a patient with fewer. However, the benefits of PrEP may extend beyond these measurable risk factors. Some individuals who are at lower risk may choose to use PrEP to reduce sexual anxiety and allow for more intimacy. The decision to use PrEP may be based on a variety of factors including sexual practices, choice of partners, use of other preventative measures, and ability to adhere to a daily regimen of medication. Your provider can help you thoroughly examine the risks and benefits of the medication before you decide if you’d like to be on PrEP or not. PrEP can’t prevent you from getting other STIs, and condoms protect against most but not all of them. This is why PrEP is best used as part of a comprehensive sexual health strategy in concert with other methods.

The Washington State Department of Health recommends that healthcare providers discuss PrEP with any of the following groups who may be at increased risk of HIV infection:

Men who have sex with men and transgender persons who have sex with men if the patient has either of the following risks:
- Condomless anal sex outside of a long-term, mutually monogamous relationship with a man who is HIV negative. Some authorities recommend PrEP to all men who have unprotected receptive anal intercourse outside of a mutually monogamous relationship with an HIV-uninfected partner.
- Diagnosis of urethral gonorrhea or rectal chlamydial infection in the prior 12 months.
Persons in HIV-serodiscordant (one HIV positive and one HIV negative partner) relationships in which the female partner is trying to get pregnant
Persons in ongoing sexual relationships with HIV positive persons who are on antiretroviral therapy and are virologically suppressed.
Women who provide sex for money or drugs.
Persons who inject drugs that are not prescribed by a medical provider.
Persons seeking a prescription for PrEP
Persons completing a course of antiretrovirals for non-occupational exposure to HIV infection.

What about the side effects of PrEP?

PrEP is generally well-tolerated, and the most common side effects reported by individuals taking PrEP in studies are headache, nausea, and loss of appetite. These effects generally clear within a few weeks to a month of using PrEP. There are rare kidney and bone-related side effects associated with the use of the medication, which is why it’s important to follow-up with your doctor as directed and to be screened for pre-existing conditions that may complicate the use of PrEP.

How do I start PrEP?

The process of starting PrEP usually involves a few office visits where education around PrEP, questions about PrEP, readiness, HIV/STI testing, and prescription are addressed. The first visit involves HIV/STI testing to ensure the individual is not HIV positive as PrEP alone isn’t adequate medication to treat HIV. Subsequent visits are structured around monitoring the experience on PrEP including adherence, side effects, and other concerns. At subsequent visits, your provider may discuss your interest in continuing to use PrEP, and revisit the benefits respective of patient risk factors. The first follow-up visit is usually a month after the initial appointment. After that visit follow-up is generally in three-month intervals to re-evaluate and continue use if indicated.

How can I pay for PreP?

Many insurance programs now cover PrEP. In addition, Gilead (the makers of PrEP) and the State of Washington both have drug assistance programs to help make PrEP more accessible. The Washington Drug Assistance Program link can be accessed below, and requires a medical provider to complete, but can help offset the cost of the drug.

If you’re interested in scheduling an appointment to discuss PrEP further or to see how it may be helpful for you, please call contact us to schedule an appointment.

Links

https://www-ncbi-nlm-nih-gov.proxy.heal-wa.org/pubmed/27149090?dopt=Abstract

http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/HIVAIDS/HIVCareClientServices/PrEPDAP