The Facts About Pre-Exposure Prophylaxis (PrEP): Is It For You?
By Christine Teague, PharmD, MPH, AAHIVP, CAMC Ryan White Program Director
By now, you have probably heard or read about PrEP, which stands for Pre-Exposure Prophylaxis:
- Pre = before,
- Exposure = coming into contact with HIV,
- Prophylaxis = treatment to prevent an infection from happening
Clinical studies have shown that one pill taken every day helps prevent HIV infection. This pill contains two medicines that we already use, in combination with other medicines, to treat HIV infection. When someone is exposed to HIV through unprotected sex or injecting drug use, PrEP can help stop the virus from turning into a permanent infection.
PrEP is another powerful tool that we have in our HIV prevention tool belt. It can be combined with condom use and other prevention methods for even greater protection than when used alone. If you choose to use PrEP, you must commit to taking the drug daily and seeing your health care provider every three months for follow up HIV and other STD testing and monitoring for medication side effects.
Most of the clinical trial studies tested a combination of two antiretroviral HIV medicines, tenofovir (brand name Viread®) and emtricitabine (also known as FTC or brand name Emtriva®). This combination pill (brand name Truvada®) was approved by the FDA in 2004 for treatment of HIV infection when combined with other antiretrovirals and in July 2012 for PrEP.
In all of these studies, the risk of getting HIV infection was lower – up to 92 percent lower – for study participants who took the medicines consistently than for those who did not take the medicines.
Who should consider PrEP?
There are new federal guidelines regarding optimal use of PrEP. These guidelines recommend that it be considered for people who are HIV-negative and at substantial risk for HIV infection.
Sexual transmission:
- Anyone who is an ongoing relationship with an HIV-positive partner
- Anyone who is not in a monogamous relationship with a partner recently tested HIV-negative
- Anyone who is a:
- Gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the past 6 months, OR
- Heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (such as people who inject drugs or have bisexual male partners).
For people who inject drugs:
Includes those who have injected illicit drugs in the past six months and have shared injection equipment or been in drug treatment for injecting drug use in the past six months.
Risk reduction
Because no prevention strategy is proven to be 100 percent effective, people who decide to take PrEP are strongly encouraged to use other prevention strategies to maximally reduce their risk:
- Using condoms consistently and correctly
- Getting regular HIV testing with partners
- Choosing less risky sexual behaviors, such as oral sex
- For injecting drug users, getting into drug treatment programs and using sterile equipment
In summary, PrEP is a powerful new strategy that can be used in conjunction with other prevention methods to reduce the risk of HIV transmission. It is recommended for those that are at highest risk and for those willing to commit to taking medication daily and regular medical follow up. Ask any of your health care team if you or your sexual partner(s) should consider a PrEP program.
References:
www.cdc.gov
US Public Health Service. Preexposure Prophylaxis for the Prevention of HIV Infection in the United States – 2014 Clinical Practice Guideline
