PrEP stands for pre-exposure prophylaxis, and it is increasingly being used by HIV negative individuals to protect them from contracting HIV. This guide can help you decide if taking PrEP is a good decision for your health.
What is PrEP?
PrEP is a single pill that combines two antiretroviral drugs: tenofovir disoproxil fumarate and emtricitabine. Many people with HIV have been taking these drugs for years, and recent studies have shown that it can prevent transmission of the virus when taken daily by uninfected individuals. Strict adherence to PrEP can reduce sexual transmission of HIV by up to 99 percent. Research has also shown that PrEP can lower the risk of infection through intravenous drug use by at least 75 percent. PrEP does not prevent pregnancy or the spread of other sexually transmitted infections such as gonorrhea, chlamydia or syphilis.
Who Does PrEP Work For?
Clinical studies have proven that PrEP works equally well for adult men, women and transgender individuals regardless of sexual orientation. PrEP is also equally effective for "tops" and "bottoms," or those who engage in either penetrative or receptive anal, oral or vaginal intercourse. No interactions between PrEP and hormone replacement therapies for gender transition have been documented, although more research is being conducted to make sure. Studies are currently underway to determine if PrEP is safe and effective for youth under 18 years old. PrEP is especially recommend for individuals who:
- Use condoms only sometimes or not at all
- Have contracted other STIs
- Have previously taken post-exposure prophylaxis, or PEP
- Have sexual partners who are HIV positive
- Are in an open relationship or have multiple sexual partners
- Are in a geographic area or demographic with a high percentage of HIV infections
PrEP is for Prevention, PEP is for Exposure
PrEP should not confused with PEP, or post-exposure prophylaxis, which is a month-long regimen of drugs that can help prevent infection if started within 72 hours after someone has been exposed to HIV. PrEP is only effective if taken consistently before exposure. If you are not on PrEP and believe that you've had an HIV exposure in the past 72 hours, call your doctor or go to a local emergency room.
PrEP for Serodiscordant Couples
PrEP is especially popular among patients in serodiscordant relationships who wish to discontinue using condoms. A serodiscordant relationship is when one partner has HIV and the other does not. HIV positive individuals who are on treatment and have an undetectable viral load already pose a lesser risk of transmitting the virus to others, but taking PrEP can provide extra protection for the HIV negative partner; however, keep in mind that PrEP is not a contraceptive and does not prevent pregnancy or the transmission of other STIs. Taking PrEP will not affect the medications of your HIV positive sexual partners.
It is not safe for serodiscordant couples to share medications. HIV positive individuals must strictly adhere to their daily regimen lest they risk developing resistance to antiretroviral drugs. Self-medicating carries many risk, so talk to your healthcare provider about your decision to try PrEP.
PrEP and Condom Use
If PrEP is taken daily, it can reduce the risk of HIV transmission from sexual intercourse up to 99 percent regardless of condom use. However, unlike PrEP, condoms also provide protection against pregnancy and most other STIs. For this reason, many people who take PrEP choose to continue using condoms.
Research suggests that people who only sometimes use condoms are just as at risk for HIV as people who never use them, so PrEP is especially recommend for individuals who do not use condoms every time they have sex.
Starting PrEP and Ongoing Check-Ups
Starting PrEP entails a great degree of commitment and responsibility. To be maximally effective at preventing HIV transmission, one pill must be taken every day. PrEP can be taken with or without food, but it should be taken around the same time each day. Once starting PrEP, you should also have blood work conducted every three months because the medications in PrEP have been known to impair kidney functions in some patients. You should also continue getting tested for HIV every three months.
Before taking PrEP, you must be absolutely sure that you do not have HIV. PrEP cannot treat HIV on its own, and taking PrEP by itself when you have HIV can lead to drug resistance, which means the virus can become immune to other anti-HIV medications. The best way to make sure you are HIV negative is to get an RNA test. Standard HIV tests look for HIV antibodies, which take up to six months after infection to develop. An RNA test checks for the virus itself, so it can tell you for certain whether you have HIV or not.
If you contract HIV while on PrEP, you can still live a normal and healthy life, but it is vital that you start taking other medications to prevent the progression of AIDS. Your doctor can help you get the physical care you need, and your friends, family and psychological health care providers can provide emotional support for managing a chronic illness.
PrEP can be discontinued at anytime and will not make your risk for contracting HIV higher than it was prior to when you started PrEP; however, it is recommended to keep taking PrEP for at least a month after your most recent possible HIV exposure.
You must take PrEP consistently for at least seven days for it to effectively begin preventing HIV transmission. If you miss a dose, PrEP may still reduce your risk of contracting HIV, but its effectiveness will significantly decrease.
PrEP Side Effects
The most common side effects reported by people when they start taking PrEP are fatigue, nausea, dizziness and vomiting, but these symptoms usually go away after a few weeks. Taking PrEP right before bedtime can help you better cope with these side effects. No sexual side effects have been documented due to taking PrEP.
PrEP has been known to affect kidney functions in some patients. Kidney problems do not always cause immediately noticeable physical symptoms, which is why people taking PrEP must routinely see a doctor for blood analysis.
Some patients also experience a small decrease in bone mineral density within the first month of taking PrEP. This decrease is usually minute and is only a concern for patients with preexisting bones problems. This symptom does not get worse over time, and bone density returns to normal if PrEP is discontinued.
Because older anti-HIV drugs were highly toxic, many people are worried about the safety of taking PrEP. One of the most common side effects of older antiretrovirals was redistribution of body fat, but this symptom is not associated with the drugs in PrEP. In fact, PrEP and other newer antiretrovirals do not appear to have any long term health effects other than preventing the spread of HIV.
PrEP and Other Drugs
PrEP's efficiency is unaffected by alcohol and recreational drugs. PrEP also doesn't interact with antidepressants or other prescription psychiatric drugs. Talk openly with your doctor about all of the legal and illegal drugs you use before starting PrEP to make sure there are no know drug interactions.