Tuesday, September 27, 2022

Can You Be On Prep With Hiv

Important Things To Know About Prep

Can you still get HIV on PREP (HIV-AIDS pep)

Before starting PrEP, your doctor will check your health and organise some tests at your first appointment including:

  • an HIV test
  • kidney and liver function tests.

You will also receive information about how to reduce your risk of acquiring HIV.

PrEP must be taken as prescribed for maximum effective protection.

How Can Providers Tell Someone Is Taking Prep As Prescribed

There are ways a provider can explore whether youre taking PrEP as prescribed. In most cases, they will simply ask you about taking your medication and any obstacles you may have to using it consistently. Some research trials and clinical demonstration projects use methods such as measuring pill counts in bottles, tracking pharmacy refills, and testing blood plasma.

The newer technology of dried blood stain testing, which first became available in 2011, allows researchers to see a timeline of adherence going back four to eight weeks. Even newer advances in hair analysis can show a time of adherence going back approximately 90 days. Although DBS tests and hair analyses are not commercially available, they can be accessed through an ongoing study at University of California-San Francisco.

The SERO PrEP Initiative is a resource provided by Grants laboratory for people who may have become HIV infected after receiving PrEP, and it offers confirmatory lab tests and other services free of charge.

When providers and patients follow established protocols, meet with each other regularly, and communicate openly and honestly, then PrEP can play a significant role in lowering HIV rates among individuals, groups, and larger communities. But exactly how well does it work, and why does it occasionally fail?

TheBody will remain a fact-based resource for empirically driven research updates as they become available in these cases, and for additional reports in the future.

Does Menstruation Raise The Risk Of Hiv Transmission To Sexual Partners In Other Ways

If a person living with HIV is not taking antiretroviral treatment, levels of HIV in their vaginal fluid are likely to be higher during menstruation. Several studies have shown that viral load in the female genital tract can vary during the menstrual cycle, including a 2004 study which found that viral load levels in cervico-vaginal fluid tended to peak at the time of menstruation and fall to the lowest level just prior to ovulation, usually midway through the cycle. This would raise the risk of HIV transmission if preventative methods werent being used.

However, due to the effectiveness of HIV treatment, the bodily fluids of someone living with HIV are likely to have no detectable virus . Levels of HIV in blood and cervico-vaginal fluid are usually correlated, although viral load in vaginal secretions may fall more slowly than in blood so may not be undetectable for a few months after viral load has become undetectable in blood.

Measurement of the amount of virus in a blood sample, reported as number of HIV RNA copies per milliliter of blood plasma. Viral load is an important indicator of HIV progression and of how well treatment is working.

If unsure, condoms, dental dams and PrEP are all options that reduce the risk of HIV infection during sex with a person living with HIV who is menstruating.

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What Is Prep And Who Should Consider It

PrEP is a daily pill taken to lower a persons risk for getting HIV. It works best as part of a program of preventive services that includes regular HIV testing.

Global research during the past decade shows that a combination of two antiretroviral medicines is more than 90% effective at preventing HIV. These medicines, emtricitabine and tenofovir disoproxil fumarate, are known by the brand name Truvada. Along with other medicines, they are also used to treat HIV.

The Centers for Disease Control and Prevention and many expert guidelines recommend PrEP for those at high risk for HIV, including

  • men who have sex with men
  • heterosexual men and women who have high-risk exposure
  • people who inject drugs
  • transgender women.

Currently, 50% of new HIV cases in the US occur among Black and Latino gay and bisexual men. Slightly more than 15% occur among heterosexual women, roughly three-quarters of whom are women of color.

The CDC estimates that 1.1 million people in the US would benefit from PrEP, including 175,000 women and 780,000 people of color. Yet prescriptions for PrEP are sluggish, particularly in populations at increased risk. Since 2012, only 135,000 PrEP prescriptions have been filled in the US. Almost all were for men largely, white men in the Northeast and on the West Coast who have sex with men.

> > can Prep Replace Condoms

Thank to PrEP and PEP, you can protect yourself and love ...

PrEP is an additional level of protection against HIV.

The FDA recommends that you use PrEP with condoms to maximize your protection against HIV and other STIs. However, PrEP can help lower your risk of contracting HIV even in situations where you dont use a condom. PrEP does not protect you against other STIs, such as Hepatitis C.

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How Much Does Prep Cost

Most health insurance plans, including Medicaid, cover PrEP. Check with your insurance company to see if PrEP is covered on your plan. You might also be able to get help with other expenses, like copays, coinsurance, and deductibles, through Gilead or patient advocacy groups like the Patient Advocate Foundation.

If you dont have health insurance, you can still get help paying for PrEP. Gilead has a medication assistance program that could make PrEP free for you, depending on your income. Your doctor or nurse will need to submit an application for you to find out if you qualify.

The staff at your local Planned Parenthood health center can also help you apply for health insurance or assistance programs that can make PrEP affordable for you.

How Do I Get Prep

You can get PrEP from some health clinics or Planned Parenthood health centers, local health departments, and doctors offices.

Your nurse or doctor will talk with you about the sex you have, the protection you use, and your medical history to see if PrEP is right for you. Theyll also give you tests for HIV, Hepatitis B and C, and other STDs. And they’ll test your kidneys to make sure theyre working well.

Some nurses and doctors dont know about PrEP, or they dont want to prescribe it because they dont have all the facts about PrEP. If you dont have a doctor, or your regular doctor or nurse doesnt prescribe PrEP, you still have options. The doctors and nurses at your local Planned Parenthood health center can provide up-to-date, accurate, non-judgmental information about PrEP, and help you get a prescription if PrEP is right for you.

There are also other organizations that can help you get and pay for PrEP. Greater than AIDS has a tool that can help you find PrEP near you.

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Do I Still Need To Use Condoms If Im Undetectable

HIV medicines only prevents HIV transmissionthey dont prevent other sexually transmitted infections , either from you to others, or others to you. Condoms are still very useful, especially if youre having sex with multiple partners or in situations when you dont know if your partner could have a detectable HIV viral load or might have an STI. I do recommend that people strongly consider using condomsbut its often for the other STIs or due to an unknown HIV status of their partners.

Is Prep Right For Me

can you be hiv positive and test negative (false hiv negative test)

PrEP is an easy and effective way to prevent HIV. Only you can decide if PrEP is a good addition to whatever you are already doing to take care of your sexual health. Consider PrEP if you are:

  • Having trouble taking steps to lower the chances of getting HIV when having sex
  • Doing a lot to lower the chances of getting HIV, but want to do even more

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Who Should Consider Taking Prep

PrEP is for people without HIV who are at very high risk for getting it. This includes:

Gay/bisexual men who

  • Have an HIV-positive partner
  • Have multiple partners, a partner with multiple partners, or a partner whose HIV status is unknown and
  • Have anal sex without a condom OR
  • Have been diagnosed with a sexually transmitted disease in the last 6 months

Heterosexual men and women who

  • Have an HIV-positive partner
  • Have multiple partners, a partner with multiple partners, or a partner whose HIV status is unknown and
  • Dont always use a condom when having sex with people who inject drugs OR
  • Dont always use a condom when having sex with bisexual men

People who inject drugs and

  • Share needles or other equipment to inject drugs OR
  • Are at risk for getting HIV from sex

If you have a partner who is HIV-positive and are considering getting pregnant, talk to your health care provider about PrEP. Taking it may help protect you and your baby from getting HIV infection while you try to get pregnant, during pregnancy, or while breastfeeding.

Ready Set Prep Expands Access To Hiv Prevention Medications

The Ready, Set, PrEP program provides free PrEP HIV-prevention medications to thousands of people living in the United States including tribal lands and territories who qualify. It expands access to PrEP medications to help reduce the number of new HIV transmissions and bring us one step closer to ending the HIV epidemic in the United States.

More than 1 million people in the United States could benefit from PrEP medications, but less than one-third of them are taking it. To address a cost barrier for some individuals who might otherwise wish to use PrEP, the U.S. Department of Health and Human Services launched Ready, Set, PrEP in December 2019, as an integral part of the federal effort to end HIV in the United States.

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How Often Are Medical Appointments For Prep

People who want to take PrEP to prevent HIV can work with their healthcare provider to determine the schedule of medical appointments that best meets their needs. Here is a general description of the schedule of medical appointments for PrEP.

  • Initial Medical Appointment: This first appointment includes education about PrEP, a discussion about readiness to take PrEP, a review of daily versus on-demand PrEP, HIV testing, and other lab work. If the person is ready to start PrEP, the medication can be started right after the initial medical appointment.
  • First Follow-Up Contact: The healthcare provider and person should make a plan for a follow-up appointment or call at a convenient time, usually within 2-4 weeks, to:
    • Check in on how things are going, including side effects
    • Troubleshoot any problems with payment or access to support services.
  • HIV testing: The person should have an HIV testevery three months to make sure they have not acquired HIV. The healthcare provider can order the testing which can be done at their office, a conveniently located CBO, health facility or lab. It is important that the results of the test are provided to the healthcare provider who prescribed PrEP.
  • Follow-Up Appointments and Prescription Refills: The frequency of follow-up appointment is established jointly by the healthcare provider and the person.

How Well Does Prep Work

How do HIV tests work and what

PrEP is very effective when you take it every day. It reduces the risk of getting HIV from sex by more than 90%. In people who inject drugs, it reduces the risk of HIV by more than 70%. PrEP is much less effective if you do not take it consistently.

PrEP does not protect against other STDs, so you should still use latex condoms every time you have sex. If your or your partner is allergic to latex, you can use polyurethane condoms.

You must have an HIV test every 3 months while taking PrEP, so youll have regular follow-up visits with your health care provider. If you are having trouble taking PrEP every day or if you want to stop taking PrEP, talk to your health care provider.

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Tests To Have Before You Start

You should have these tests done before starting PrEP or around the same time. If youve already started PrEP, get them done as soon as you can.

  • HIV: Fourth-generation blood test, able to detect antibodies and p24 antigen
  • Kidney function: test for protein in urine
  • Kidney function: test for creatinine and eGFR in blood
  • Sexually transmitted infections

Its important to be sure that you dont have HIV without realising it if you did have HIV, taking PrEP could mean you develop resistance to drugs you may need for treatment.

Make sure you have a fourth-generation blood test for HIV. This tells you your HIV status four weeks ago. Other tests, including ones which provide a result immediately and ones which you use at home, are not as good at picking up recent infections.

If youve taken any risks in the four weeks before taking the test, you can start PrEP but its a good idea to repeat the test four weeks later. This is just to check that a recent infection was not missed.

If youve recently taken a risk and have flu-like symptoms, dont start PrEP. You need to rule out the possibility that these are the symptoms of recent HIV infection. Go to a sexual health clinic as soon as possible for advice and testing.

The hepatitis B test is essential because PrEP drugs are active against hepatitis B. You could still use PrEP, but youd need a doctors advice on the safest way to do so.

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How Do I Take Prep

There are two ways to take PrEP:

One tablet per day

  • women
  • transgender men having vaginal/frontal sex
  • men having vaginal or anal sex with women
  • gay and bisexual men

Things to consider:

You will need to take PrEP for 7 days before you are protected, and then every day for as long as you want protection.

Event-based where you take PrEP before and after planned sex

Recommended for:

  • gay and bisexual men

Things to consider:

This option would work for you if you are able to plan for sex at least two hours in advance or you can delay having sex for at least two hours.

There are different types of event-based PrEP depending on your pattern of sexual activity, so make sure you talk this option through with a health professional.

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What Is Prep How Does It Work

PrEP stands for pre-exposure prophylaxis. Its a pill you can take when you dont have HIV but are likely to get the virus, perhaps because of sex or injection-drug use. It helps before youre infected, so HIV cant settle into your body and spread.

The PrEP medications sold as Descovy or Truvada, which are a combination of two drugs tenofovir and emtricitabine which taken correctly prevents HIV from taking hold in your body. Theres no generic version of PrEP yet.

You need to take PrEP medicine once a day, every day.

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What Are The Other Possible Side Effects Of Truvada For Prep

PrEP – an HIV prevention option

Serious side effects of TRUVADA may also include:

  • Kidneyproblems, including kidney failure. Your healthcare provider should do blood and urine tests to check your kidneys before and during treatment with TRUVADA. If you develop kidney problems, your healthcare provider may tell you to stop taking TRUVADA.
  • Too much lactic acid in your blood , which is a serious but rare medical emergency that can lead to death. Tell your healthcare provider right away if you get these symptoms: weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, stomach pain with nausea and vomiting, cold or blue hands and feet, feel dizzy or lightheaded, or a fast or abnormal heartbeat.
  • Severe liver problems, which in rare cases can lead to death. Tell your healthcare provider right away if you get these symptoms: skin or the white part of your eyes turns yellow, dark tea-colored urine, light-colored stools, loss of appetite for several days or longer, nausea, or stomach-area pain.
  • Bone problems, including bone pain, softening, or thinning, which may lead to fractures. Your healthcare provider may do tests to check your bones.

Common side effects in people taking TRUVADA for PrEP are headache, stomach-area pain, and decreased weight. Tell your healthcare provider if you have any side effects that bother you or do not go away.

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What Goes Into Prep

In the UK, one pill is approved for use as PrEP the branded drug Truvada or its generic equivalent.

Generics contain the same ingredients as branded drugs and work in the same way.

Truvada and the generics contain two drugs:

  • Tenofovir Disoproxil TD
  • Emtricitabine FTC.

In the US a second pill has been approved for use as PrEP the branded drug Descovy or its generic equivalent.

  • Tenofovir Alafenamide TAF

Why Should I Take Prep Medication

PrEP medications allow those at risk for HIV to take control of their health and reduce their risk. If you are at risk of HIV exposure through sex or injection drug use, ask a health care professional if PrEP is right for you. PrEP medications only protect against HIV, so condoms are still important to prevent other sexually transmitted infections.

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Cases Of Hiv Seroconversion On Prep With Verified Adherence

  • Location: Toronto, CanadaReceived resistant strain? YesAdherence confirmed by dried blood stain test? YesDescription: A 43-year-old gay man seroconverted after two years on PrEP. Dried blood spotting tests demonstrated greater than adequate adherence at the time of seroconversion. His strain suggested that he acquired a virus resistant to the same medications found in the drug Stribild .

  • Received resistant strain? NoAdherence confirmed by DBS? YesDescription: A 50-year-old gay man in a PrEP demonstration project seroconverted HIV eight months after starting PrEP. Dried blood spotting tests demonstrated greater than adequate adherence at the time of seroconversion. He did not acquire a strain of HIV that is resistance to medications.

  • Received resistant strain? YesAdherence confirmed by dried blood stain test? Yes, as well as hair samplingDescription: A 21-year-old Latinx man acquired HIV between months 10-13 of using PrEP. He had been confirmed as HIV negative at initiation, as well as months 3, 6, and 10. Through hair sampling it was verified he had more than adequate adherence from the previous 6 months. His strain of HIV was resistant to the same medications as his primary partner. His viral load was quickly brought down to undetectable.

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