Does Prep Have Risks
People with HIV have used Truvada, tenofovir and emtricitabine, for several years. They are generally easy to take. Possible long-term side effects include loss of bone mineral density and kidney damage.
Some people worry that people taking PrEP might think they are totally protected. They might be less careful about their sexual behavior. So far, this does not appear to be true.
What Medications Are Used In Prep
The pill approved by the U.S. Food and Drug Administration for daily use as PrEP for people at very high risk of getting HIV infection is called Truvada®. Truvada® is a combination of 2 HIV medications . These medicines work by blocking important pathways that HIV uses to set up an infection. If you take PrEP daily, the presence of the medicine in your bloodstream can often stop HIV from taking hold and spreading in your body. If you do not take PrEP every day, there may not be enough medicine in your bloodstream to block the virus. PrEP can only be prescribed by a healthcare provider and must be taken as directed to work.
How Will My Patients Pay For Prep Medication Clinical Visits And Lab Tests
Most insurance plans and state Medicaid programs cover PrEP. Prior authorization may be required.
Patient assistance program: There are medication assistance programs that provide free PrEP medications to people with no insurance to cover PrEP care. To learn more, call 855-447-8410 or visit www.getyourprep.comexternal icon
Co-pay assistance program: Income is not a factor in eligibility. More information is available at: Some states have their own PrEP assistance programs. Some cover medication, some cover clinical visit and lab costs, some cover both. To learn more visit:
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I Have Sex Partners Who Are Living With Hiv And Have An Undetectable Viral Load Because They Are On Hiv Treatment Do I Still Need To Take Prep
Individuals living with HIV who are taking HIV treatment consistently and have an undetectable viral load for at least 6 months cannot transmit the virus to an HIV-negative partner through sexual activity. In sero-discordant or magnetic couples , PrEP may be used by the HIV-negative partner for additional protection.
Who Can Take Prep Can You Use Prep If Youre Hiv Positive
PrEP is for anyone who may be at higher risk of HIV exposure. This might be you if you frequently have unprotected sex with different partners, if your partner is HIV positive, or if youre a sex worker or an injection drug user. You may also be at increased risk if your partner engages in any of these behaviours.
Because PrEP is a preventative course of medication, you should only take it if youre HIV-negative. If you know or suspect that youre HIV-positive, or think youve been exposed to HIV, get tested and speak to your doctor about other forms of treatment, or about post-exposure prophylaxis . Taking PrEP when youre HIV-positive can make you resistant to the medication, limiting your future treatment options.
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Who Should Use Prep
- PrEP should be used by people who are at high risk of becoming infected with HIV by sexual activity
- PrEP should be part of an overall HIV prevention program including condoms and counseling
- Before taking PrEP, people should be tested to confirm that they are not already infected with HIV
- People using PrEP should continue to be tested to make sure they have not been infected
- They should also be tested for kidney damage, hepatitis B and any sexually transmitted diseases
Is The Prep Medication Effective For Treating Hiv Infection
PrEP medications are not effective alone for treating HIV infection. If you acquire HIV infection while taking PrEP, the provider who conducted the HIV test should either provide HIV medical care or refer you to a healthcare provider who can provide HIV care. The HIV care provider will conduct lab tests and determine the most effective regimen to treat your HIV infection. There is no evidence that having taken PrEP will impact the effectiveness of your HIV treatment. People who acquire HIV while on PrEP can be successfully treated with HIV medications.
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What Baseline Assessment Is Required For Individuals Beginning Prep
HIV Testing
HIV testing is required to confirm that patients do not have HIV infection when they start taking PrEP. While antigen/antibody tests are preferred, at a minimum, clinicians should document a negative antibody test result within the week before initiating PrEP medications. The required HIV testing can be accomplished by drawing blood and sending the specimen to a laboratory for testing or performing a rapid, point-of-care FDA-approved fingerstick blood test. Oral rapid tests should not be used to screen for HIV infection when considering PrEP use because they can be less sensitive than blood tests. A listing of FDA-approved HIV tests, specimen requirements, and time to detection of HIV infection are available online at: www.cdc.gov/hiv/testing/laboratorytests.html
Since PrEP is indicated for individuals who report sexual or injection behaviors that place them at risk of HIV acquisition, clinicians should suspect acute HIV infection in persons known to have been exposed recently. Clinicians should solicit a history of signs or symptoms of viral infection during the preceding month or on the day of evaluation in all PrEP candidates with a negative or an indeterminate result on an HIV antibody test.
For patients with signs/symptoms of acute HIV infection within the prior four weeks, the following options are suggested:
Hiv Prep Update For Primary Care Providers Webinar
If you are a primary care provider, you can access ASHM’s latest HIV PrEP Update for Primary Care Providers webinar series by clicking HERE. You can also register to attend ASHM HIV PrEP trainings through ASHM Training page HERE.
These training sessions provide GPs, Nurses and Health Professionals working in primary care an update on strategies available for the prevention of HIV transmission, focusing on prevention particularly Pre-Exposure Prophylaxis .
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Changes In Sexual Practices Among Persons Receiving Prep
Critics of PrEP have argued that its use will lead to behavioral disinhibition and an increase in higher risk sexual and drug use practices, an effect labeled risk compensation. The evidence in PrEP clinical trials for risk compensation in the setting of PrEP use has been mixed. In addition, clinical experience suggests risk behaviors in the community setting may not parallel those in PrEP clinical trials, since individuals are likely to receive more extensive and frequent counseling for HIV prevention measures in these trials. Regardless, most experts believe the HIV prevention value of PrEP outweighs any potential change in sexual practices that may occur while persons are receiving PrEP. The following summarizes key findings in major PrEP studies that have examined the impact of PrEP on sexual activity and rates of sexually transmitted infections.
How Does Prep Work To Help Prevent Hiv
PrEP interferes with the pathways that HIV uses to cause a permanent infection. For HIV to cause infection the virus must gain entry into the body, infect certain immune cells, make copies of itself within these immune cells, then spread throughout the body.
When PrEP is taken consistently and correctly, antiretroviral drugs get into the bloodstream and genital and rectal tissues. The drugs work to help prevent HIV from replicating within the bodys immune cells, which helps to prevent a permanent infection.
For PrEP to help stop HIV replication from happening, drug levels in the body must remain high. If pills are not taken consistently as prescribed there may not be enough medication in the body to reduce the risk of HIV infection.
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What Is Prep Prescription Hiv Prevention 101
Get the basics on PrEP, PrEP 2-1-1, & PEP to keep it safe.
PrEP stands for pre-exposure prophylaxis, a type of medication taken before possible contact with HIV , a virus that can weaken the immune system by attacking certain white blood cells .
The most widely known and used HIV-preventative method is by far daily PrEP. But there are two other methods that are used as-needed: PrEP 2-1-1 and PEP. These additional methods are less widely prescribed, and have much more narrowly defined windows to be effective. Across all forms of PrEP, cost has been the biggest barrier to access , but with the recent expiration of the patent for Truvada, things are changing.
First: the chances of getting HIV vary depending on the circumstances.
In simplest terms: an HIV infection can occur only if one comes into contact with the virus. Its not something spontaneous. Those most at risk for contracting HIV are those who:
- Have a sexual partner who is HIV positive and has detectable virus in the blood or a partner whose HIV status is unknown
- Have another sexually transmitted infection, such as gonorrhea
- Use condoms consistently or not at all
In order to avoid contracting HIV, there are three different available prescription treatments.
Daily PrEP
Descovy has not been studied for prevention during vaginal sex or with injection drug use.
PrEP 2-1-1
PrEP 2-1-1 is named for its dosing:
PEP
Knowing those barriers, the two main options to get a PEP prescription are:
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What Are Some Other Benefits Of Prep
PrEP has benefits beyond preventing HIV. If you worry about getting HIV during sex, being on PrEP can help you feel less anxious about getting HIV.
PrEP is a way to help prevent HIV that you can control without your sex partner knowing that you are using it.
You can be on PrEP for as long or as short a time as you want. Many guys only use PrEP for a period in their life when they need it, based on their risk for HIV at the time.
If you want to stop taking PrEP, or restart after a period of not taking PrEP, talk to your healthcare provider about how to stop and/or restart PrEP safely.
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How Well Does Daily Prep Work
PrEP using TDF + FTC
A large body of evidence shows that daily PrEP is highly effective at reducing the risk of HIV acquisition when it is used consistently and correctly. Daily PrEP was initially proven effective on the basis of evidence from randomized controlled trials conducted in gbMSM, in transgender women and in heterosexual men and women. In addition, limited evidence from one RCT found that daily PrEP , is effective at reducing the risk of HIV transmission among people who inject drugs when it is used consistently and correctly.
In all the RCTs, PrEP was provided as part of a comprehensive prevention package that included regular medical appointments for HIV testing, testing and treatment for sexually transmitted infections , risk reduction counselling and adherence counselling.
The overall reduction in HIV risk provided by PrEP in the RCTs ranged from zero to 86%, but these analyses did not consider whether people were taking the study drug as prescribed. Adherence is crucial for PrEP to work. The evidence shows that higher adherence is associated with greater protection. To demonstrate the importance of adherence, some of these studies conducted adherence analyses that compared the risk of HIV infection among participants who had PrEP drugs detected in their blood with the risk among those who did not. These analyses found that the use of PrEP reduced the risk of sexual HIV transmission by between 85% and 92% among gbMSM and heterosexual men and women.
Can Prep Be Stopped And Restarted Safely
PrEP can be safely stopped and started again based on a persons risk for HIV. If a person wants to stop taking PrEP, or restart after a period of not taking PrEP, they should talk to their healthcare provider about how to stop and/or restart PrEP safely.
Generally, when stopping daily PrEP, it is recommended that the medication be continued for some time after the last possible exposure to HIV. It is recommended that gbMSM, whose risk for HIV is via anal sex, can stop taking daily PrEP two days after their last sexual encounter. For everyone else , the ideal number of days to take PrEP after their last exposure to HIV is unknown it could be up to 28 days.
GbMSM who use on-demand PrEP should follow the on-demand schedule and continue taking PrEP for two days after the last time they have sex. PrEP can then be stopped safely.
If a person who has stopped taking PrEP wants to restart, they should be tested for HIV before starting again if there has been any possible HIV exposure since they last took PrEP. PrEP is only for HIV-negative people if a person has HIV, they need HIV treatment. People starting daily PrEP should wait seven days after their first dose before having anal, vaginal or frontal sex.
GbMSM also have the option of restarting PrEP using an on-demand strategy, but they may need to be tested for HIV first. This could be a good option for men who know in advance when they will have sex or who find they are having sex less often.
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What Are The Side Effects Of The Prep Medications
Truvada and Descovy are both recognized as well-tolerated medications with few side effects.
In clinical trials, only a small number of people found the side effects serious enough to stop taking the medication. People taking PrEP should discuss any side effects they experience with their healthcare provider. In many cases, side effects are only short term and can be managed. Two important health issues related to taking PrEP include kidney function and bone density. Your healthcare provider will ask if you have a history of kidney disease and will periodically order lab work to monitor your kidney function. Bone density will be monitored as needed. The NYSDOH is aware that there are lawsuits that claim harm to individuals taking Truvada. However, scientific evidence shows that when taken as directed, Truvada is safe and effective. Since there are risks to taking any medication, individuals should speak with their healthcare provider about the benefits, risks , and possible alternatives for every medication they choose to take in order to understand the best choices for their specific situation.
Is Prep Right For Me
If you are HIV-negative and trying to stay that way, PrEP might be right for you. Questions to consider are:
- Do you have any sexual partners who are HIV-positive?
- Do you have anal or vaginal sex without using a condom?
- Have you been treated recently for a sexually transmitted infection?
- Do you or your sex partner use IV drugs?
- Do you or your sex partner exchange sex for money, housing, or other needs?
If you answered yes to any of these questions, or anticipate answering yes to these questions in the near future, PrEP may be right for you.
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Impact On The Culture Of Men Who Have Sex With Men
PrEP is used predominantly by gay men and also by men who have sex with men, often as an alternative to condoms. For the first time since the outbreak of the AIDS crisis, PrEP makes HIV-protected sex without condoms possible and has therefore changed men who have sex with men sex culture: With the spread of PrEP, sex without condoms has increased. PrEP does offer an alternative to condoms for men who have sex with men, however it should only be used under strict professional advice and surveillance since it does not prevent the transmission of sexually transmitted infections other than HIV. The impact of PrEP has been tremendous on the sex culture of men who have sex with men, but it should be used with awareness that it is not 100% effective and it does not prevent the transmission of other sexually transmitted infections.
Where Can I Get Prep
PrEP must be prescribed by a medical provider. If you have a provider, you can ask them about starting PrEP. If you need a provider, or want a provider that already prescribes PrEP, use the resources below to find someone. Below is a list of resources to get connected with PrEP and other related services.
For transgender and gender non-conforming individuals who qualify, PrEP can be provided for participation in one of our PrEP research studies.
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I Dont Have A Gp / My Gp Doesnt Know Enough About Prep
I Dont have a GP. Where can I go to get PrEP?Halifax Sexual Health Centre: The HSHC is also now doing assessments for patients re PrEP. Anyone making an appointment with HSHC to access PrEP should clearly state so when they book their appointment. HSCH clients do not need a GP to access, or to follow up, PrEP at HSHC.
My GP Doesnt Know Enough About PrEP. What Can I do?If your doctor is new to PrEP for HIV they can get an overview of what is recommended by checking out the new Canadian PrEP protocol. Another option is physician consults: If you have a physician, your GP can refer you to other doctors for a consultation re PrEP. Dr. Glenn Andrea and Dr. Tim Matheson are willing to consult for other practitioners re assessing and prescribing PrEP at this time.
How Can Service Providers Improve The Uptake And Correct Use Of Prep
Education and counselling activities related to HIV prevention should include information on the HIV prevention benefits of PrEP, along with information on other highly effective ways to help prevent HIV. These include the use of HIV treatment to maintain an undetectable viral load, post-exposure prophylaxis , condoms for sex and new equipment for using drugs. Encourage clients to choose the combination of strategies that will work most effectively for them as there are multiple ways to prevent HIV that can be combined in different ways. PrEP only helps to prevent HIV it does not prevent other STIs or blood-borne infections such as hepatitis C. Discuss how PrEP fits into a comprehensive plan for health, such as regular STI testing, using condoms and using new drug use equipment.
PrEP is not for everyone. You can support clients to decide whether PrEP is right for them. During discussions, help your clients consider their level of HIV risk and the possible side effects, as well as their ability to cover the cost , access a knowledgeable healthcare provider, adhere to a pill-taking regimen and attend regular medical visits. Each person has the right to decide whether or not to use PrEP as a prevention approach, on the basis of their own assessment of what is best for their health and well-being.
For people who are interested in taking PrEP, provide education on how to use it correctly, to maximize safety and effectiveness. Emphasize the following:
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