Offering hope in the fight against HIV
Just a generation ago, millions of people infected with HIV faced the likelihood of eventually dying from AIDS. Then breakthrough treatments turned HIV infection into a largely treatable condition.
Now, some of the same medications used to treat the infection are helping to prevent it altogether.
Americans at risk for HIV increasingly are turning to Truvada — a pre-exposure prophylaxis, or PrEP, approved as a prescription drug in 2012. When taken consistently, this combination of the HIV drugs tenofovir and emtricitabine can dramatically reduce the odds of HIV infection.
We talked to Gregory Rauch, MD, a primary care physician at Rush whose clinical expertise includes PrEP and LGBTQ health, to learn more about the drug that offers hope in the fight against HIV.
1. PrEP is for people at high risk.
Doctors recommend PrEP for anybody who is considered at high risk for HIV infection.
"That includes people who have multiple sexual partners, and people who are in a relationship with an HIV-positive partner," Rauch says.
It's also recommended for intravenous drug users who share needles. "It's best to always use clean needles," Rauch says, "but if there's any chance of IV drug users sharing needles, PrEP would be a good idea."
2. PrEP is not a substitute for safe sex.
Although PrEP reduces the risk of getting HIV from sex by more than 90 percent when taken regularly, people still need to practice safe sex by using a condom.
For one thing, there's still a limited chance of acquiring HIV even while on PrEP. And the pill doesn't prevent other sexually transmitted diseases, including hepatitis B, hepatitis C and human papillomavirus (HPV).
"I tell patients to look at it as a safety net rather than actual complete prevention," Rauch says. "You should still use condoms. You should still take whatever precautions you would have normally taken had you not been using PrEP."
PrEP is most effective after about 20 days of continuous use. And it must be taken every day for maximum effectiveness.
3. PrEP requires routine supervision by your doctor.
Before prescribing the pill, Rauch orders an HIV test to confirm the patient is HIV negative, along with basic lab work to get a blood count and check kidney and liver function.
The kidney test is performed to ensure the drug will be metabolized properly and to watch for potentially dangerous buildup of lactic acid, Rauch says. There's also a risk of liver problems if the drug is used in combination with other antiretrovirals.
Once on PrEP, you’ll need to see your doctor at least every three months for further monitoring. CDC guidelines recommend repeat HIV testing at three months, and tests for kidney function every six months.
4. Insurance covers PrEP.
PrEP is covered by most insurance plans, including Medicaid, but because it's an expensive medication some patients may encounter relatively high copays. Assistance may be available, though, through the drug manufacturers and patient advocacy organizations.
Look at it as a safety net rather than actual complete prevention ... You should still take whatever precautions you would have normally taken had you not been using PrEP.
5. Side effects are usually manageable.
The most common side effects from PrEP include nausea, headaches and fatigue, but most people tolerate it well, Rauch says, and the effects often diminish over time.
As for long-term effects, the Centers for Disease Control and Prevention says no serious problems were detected in patients who have been on PrEP for up to five years.
6. PrEP is not the same as PEP.
PrEP is for people who have not tested positive for HIV but who are at high risk.
PEP — or post-exposure prophylaxis — is used after possible exposure to HIV. This antiretroviral medication must be taken within 72 hours of possible exposure and continued for four weeks.
Over the last decade, the number of new HIV cases each year has fallen by 19 percent, according to the CDC. And the advent of PrEP could help hasten that decline.
"PrEP provides a much better sense of security than people may have had in the past," Rauch says, "and hopefully we'll start to see the incidence of new HIV cases go down as more people learn about and start using it."