PrEP stands for pre-exposure prophylaxis, and it is a once-daily medication meant for people who don't currently have HIV but have a high chance of contracting the virus.
HIV targets our immune system directly, aiming specifically for a type of white blood cell known as T-cells. T-cells help to coordinate our body's immune system response. However, our bodies have no natural means of preventing and getting rid of HIV. This is because HIV tricks the T-cells into providing a safe place for the virus to replicate and spread throughout the body. HIV is dependent on T-cells to live and grow. Without these cells, HIV is rendered harmless.
PrEP drugs are a class of antiviral medication called nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs). They prevent the virus from multiplying in your body by keeping the virus from entering the T cells of the immune system. Essentially, the drug puts up a wall around the T-cells preventing HIV from getting into them and reproducing.
PrEP protection is estimated to begin 7 to 20 days after the first dose. However, PrEP therapy requires periodic monitoring by a healthcare professional, usually once every one to three months.
Different Types of PrEP
There are two PrEP medications that the FDA approves. These are Truvada and Descovy.
Truvada
Truvada consists of the active ingredients, emtricitabine and tenofovir disoproxil fumarate. It comes in both brand-name and generic forms.
Truvada is also available in different strengths depending on whether the prescription is for HIV treatment or PrEP.
This medicine comes in tablet form and needs to be taken once a day by adolescents and adults who weigh a minimum of 77 pounds or 35 kilograms. Additionally, this drug is approved for use by both females and males.
Descovy
Like Truvada, the Descovy tablet is taken once a day. It contains the ingredients tenofovir alafenamide and emtricitabine. Also, like Truvada, adults, and adolescents who weigh at least 35 kilograms or 77 lbs can take this medication. However, unlike Truvada, Descovy isn't approved for females because effectiveness has not been tested in this group.
Advantages and Disadvantages of PrEP
Advantages
- PrEp drugs are highly effective at preventing HIV when taken consistently
- PrEP protects you and your partner from HIV transmission.
- It's convenient in that you only have to take one pill a day.
- It's a good option for people of mixed HIV status who want to have a baby.
Disadvantages
- PrEP side effects can include nausea, diarrhea, and headaches. Additionally, in severe cases, it can cause liver or kidney damage.
- Without insurance, the brand name PrEP drugs are expensive.
- You need to get tested for HIV every three months at a minimum.
- You have to remember to take your medicine every day.
Who Should Use PrEP?
The CDC says that in 2018, 1.2 million people in the US had contracted HIV, and of that number, 1 in 7 people didn't know they had the virus. This suggests that PrEP is beneficial to a large majority of people. However, to be specific, you might benefit from PrEP if you've had anal or vaginal sex in the last six months and:
- Did not use a condom consistently during sex
- Have contracted an STI in the last six months
- Have had a sexual partner with HIV with a detectable or unknown viral load
Additionally, if you inject drugs and share needles or have an injection partner who has tested positive for HIV, you are a good candidate for PrEP.
How Effective is PrEP?
When taken on a regular schedule as prescribed by a doctor, PrEP is highly effective against HIV. In fact, the CDC states that these drugs, when taken regularly, lower the chances of getting HIV by around 99 percent through sex and 74 percent through injecting drugs.
That being said, the medications we've mentioned here are not effective immediately. You have to take them daily for at least seven days for maximum protection from HIV transmission with bottoming anal sex.
For injection drug use or receptive vaginal sex, maximum protection happens after around 21 days of daily use.
How Safe is PrEP?
Truvada and Descovy are generally safe; however, some people may experience side effects. Therefore, you must talk with a healthcare provider about your health conditions and the side effects and benefits of PrEP before getting a prescription. For instance, if you have a serious kidney condition, these drugs may not be safe for you. Also, if you've had hepatitis B in the past, you must tell your doctor as stopping Truvada or Descovy could worsen your hepatitis B.
Final Thoughts
If you believe that you may contract HIV, you must get regular testing and talk with a counselor or doctor about the prevention steps you can take.
PrEP is just one part of the prevention strategy that a healthcare professional may recommend to you. While it is highly effective at preventing the transmission of HIV, it's not the only option. So make sure you know all your options before making your choice.
