There has been a lot of talk lately about Pre-Exposure Prophylaxis. With new research findings confirming its effectiveness, it is almost universally understood that PrEP is an exciting tool for HIV prevention. Various campaigns can be seen around the internet, praising individuals for taking the reins on their own health by choosing to take PrEP. However, the decision to take PrEP is not one to make lightly; it requires a lot of maturity, responsibility, and commitment. There are a number of factors one must consider, including insurance issues, copayments, potential side effects, and the need to adhere to a strict medication regimen. With all of these considerations, most people are wondering “How do I know if PrEP is right for me?”
Pre-Exposure Prophylaxis Guidelines
Last year, the CDC released federal guidelines for PrEP. These guidelines recommend that PrEP be considered for people who are HIV-negative and at substantial risk for HIV.
While the CDC has its own interpretation of substantial risk (which you can read here), The Men’s Health Foundation understands that in reality, crossing over from no risk to substantial risk can happen in the blink of an eye, and everyone makes risky choices sometimes. While PrEP is most highly recommended for persons of high risk (frequently having sex without a condom with persons of unknown HIV status), there is no reason to recommend against PrEP for a less “risky”, but still sexually active person who wants to take it. PrEP has been proven safe and effective in multiple international studies.
One thing that is very well understood about PrEP is that it is most effective when taken daily, as directed, and that it takes about 7 days to attain protective levels of the drug in the body’s cells. In research studies, the efficacy of PrEP decreased when participants didn’t take the medication every day. We do not have enough research to support “On Demand” PrEP. That is when a person takes two Truvada tablets, the only FDA-approved drug for PrEP, 24 hours before a planned or potential sexual encounter, then one pill immediately after sex and another pill 24 hours later, after sex. Research from the PROUD Study did demonstrate that this intermittent strategy had about a 86% reduction in the risk of HIV transmission. However, that is not the full benefit or protection that daily PrEP confers – 98% HIV prevention.
With this in mind, it is important for PrEP users understand that receiving a prescription for PrEP is not enough; they should adhere to the daily regimen in order to be protected. The goal is to make sure that everyone who believes they are protected actually is protected. Because of this, people who decide to take PrEP must decide to take it every single day, until they no longer want to take it, or until we have new drugs in the future that are longer acting and do not need to be taken daily. We are not there yet.
PrEP users must also commit to regular follow-up visits with their physician. Because of the rare, but serious side effects associated with PrEP (such as bone mineral density loss and renal toxicity), patients should return to their health care provider every 3 months for lab work. At this time, the provider can write a prescription refill, offer counseling about medication adherence and risk reduction, test for STDs if necessary, and assess side effects.
Taking PrEP, regular (every 3 months) HIV/STD testing is highly recommended to treat STDs and to make sure that if a person tests positive for HIV that they get on standard of care treatment that is three antiretroviral drugs…so that resistance to medication does not occur.