Pre-exposure Prophylaxis (PrEP) for HIV Prevention
The IUHC will be providing Pre-exposure prophylaxis (PrEP) to HIV negative patients who are at high risk of contracting the HIV virus. To discuss if you are a candidate for PrEP, please call (812) 855-7688 to schedule an appointment.
Frequently Asked Questions:
What is PrEP?
“PrEP” stands for pre-exposure prophylaxis. The word prophylaxis means to prevent or control the spread of an infection or disease. The goal of PrEP is to prevent HIV infection from taking hold if you are exposed to the virus. This is done by taking a pill that contains 2 HIV medications every day. These are the same medicines used to stop the virus from growing in people who are already infected.
Why take PrEP?
The HIV epidemic in the United States is growing. About 40,000 people get infected with HIV in the US each year. More of these infections are happening in some groups of people and some areas of the country than in others.
Is PrEP a vaccine?
No. PrEP medication does not work the same way as a vaccine. When you take a vaccine, it trains the body’s immune system to fight off infection for years. You will need to take a pill every day by mouth for PrEP medications to protect you from infection. PrEP does not work after you stop taking it. The medication that was shown to be safe and to help block HIV infection is called Truvada. Truvada is a combination of 2 drugs (tenofovir and emtricitabine). These medicines work by blocking important pathways that the HIV virus uses to set up an infection. If you take Truvada as PrEP daily, the presence of the medication in your bloodstream can often stop the HIV virus from establishing itself and spreading in your body. If you do not take the Truvada pills every day, there may not be enough medicine in your blood stream to block the virus.
Should I consider taking PrEP?
PrEP is for people without HIV who are at very high risk for getting it from sex or injection drug use. The federal guidelines recommend that PrEP be considered for people who are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner.
This recommendation also includes anyone who:
isn’t in a mutually monogamous relationship with a partner who recently tested HIV-negative, and is a . . .
- gay or bisexual man who has had anal sex without using a condom and/or been diagnosed with a bacterial STI in the past 6 months,
- heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (for example, people who inject drugs or women who have bisexual male partners).
PrEP is also recommended for people who have injected drugs not prescribed by a physician in the past 6 months and have shared needles with others.
If you have a partner who is HIV-positive and are considering getting pregnant, talk to your doctor about PrEP if you’re not already taking it. PrEP may be an option to help protect you and your baby from getting HIV infection while you try to get pregnant, during pregnancy, or while breastfeeding.
How well does PrEP work?
PrEP was tested in several large studies with men who have sex with men, men who have sex with women, and women who have sex with men. All people in these studies (1) were tested at the beginning of the trial to be sure that they did not have HIV infection, (2) agreed to take an oral PrEP tablet daily, (3) received intensive counseling on safer-sex behavior, (4) were tested regularly for sexually transmitted infections, and (5) were given a regular supply of condoms.
Several studies showed that PrEP reduced the risk of getting HIV infection.
- Men who have sex with men who were given PrEP medication to take, were 44% less likely to get HIV infection than were those men who took a pill without any PrEP medicine in it (a placebo). Forty-four percent was an average that included men who didn’t take the medicine every day and those who did. Among the men who said they took most of their daily doses, PrEP reduced the risk of HIV infection by 73% or more, up to 92% for some.
- Among men and women in couples in which one partner had HIV infection and the other partner initially did not (“HIV-discordant” couples), those who received PrEP medication were 75% less likely to become infected than those who took a pill without any medicine in it (a placebo). Among those who said they took most of their daily doses, PrEP reduced the risk of HIV infection by up to 90%.
- In one study of men and women who entered the study as individuals (not as a couple), PrEP worked for both men and women in one study: those who received the medication were 62% less likely to get HIV infection; those who said they took most of their daily doses, were 85% less likely to get HIV infection. But in another study, only about 1 in 4 women (<26%) had PrEP medication found in their blood when it was checked. This indicated that few women were actually taking their medication and that study found no protection against HIV infection.
More information on the details of these studies can be found at http://www.cdc.gov/hiv/prep.
Is PrEP safe?
The clinical trials also provided safety information on PrEP. Some people in the trials had early side effects such as an upset stomach or loss of appetite but these were mild and usually went away within the first month. Some people also had a mild headache. No serious side effects were observed. You should tell your provider if these or other symptoms become severe or do not go away.
How can I start PrEP?
If you think you may be at high risk for HIV, talk to your provider about PrEP. If you and your provider agree that PrEP might reduce your risk of getting HIV infection, you will need to come in for a general health exam, blood tests for HIV, and tests for other infections that you can get from sex partners. Your blood will also be tested to see if your kidneys and liver are functioning well. If these tests show that PrEP medicines are likely to be safe for you to take and that you might benefit from PrEP, your provider may give you a prescription after discussing it with you. Taking PrEP medicines will require you to follow-up regularly with your provider. You will receive counseling on sexual behaviors and blood tests for HIV infection and to see if your body is reacting well to Truvada. You should take your medicine every day as prescribed, and your provider will advise you about ways to help you take it regularly so that it stands the best chance to help you avoid HIV infection. Tell your provider if you are having trouble remembering to take your medicine or if you want to stop PrEP.
If I take PrEP can I stop using condoms when I have sex?
You should not stop using condoms because you are taking PrEP. If PrEP is taken daily, it offers a lot of protection against HIV infection, but not 100%. Condoms also offer a lot of protection against HIV infection if they are used correctly every time you have sex, but not 100%. PrEP medications don’t give you any protection from other infections you can get during sex, but condoms do. So you will get the most protection from HIV and other sexual infections if you consistently take PrEP medication and consistently use condoms during sex.
How long do I need to take PrEP?
You should discuss this with your health care provider. There are several reasons that people stop taking PrEP. If your risk of getting HIV infections becomes low because of changes that occur in your life, you may want to stop taking PrEP. If you find you don’t want to take a pill every day or often forget to take your pills, other ways of protecting yourself from HIV infection may work better for you. If you have side effects from the medication that are interfering with your life or if blood tests show that your body is reacting to PrEP in unsafe ways, your provider may stop prescribing PrEP for you.
Information above provided by the Centers for Disease Control and Prevention
General Information Resources:
CDC website: http://www.cdc.gov/hiv/basics/prep.html
Truvada website: http://start.truvada.com/individual
Project Inform website: http://www.projectinform.org/prep/
Positive Link: A local provider of comprehensive prevention and holistic social services for those impacted by HIV in south central Indiana. Visit https://iuhealth.org/in-the-community/south-central-region/hiv-aids-positive-link or call (812)353-9150
IUHC Health and Wellness: (812) 855-7338
PrEP video overview: http://prepdaily.org/