PrEP stands for pre-exposure prophylaxis. Currently, this acronym refers to using a drug called Truvada to prevent HIV (Human Immunodeficiency Virus) in people who are HIV negative and are at high risk of exposure to HIV. Truvada is a Gilead Sciences drug that contains two antiviral medications called emtricitabine and tenofovir disoproxil fumarate. The FDA (Food and Drug Administration) approved Truvada for HIV prophylaxis on July 16, 2012. According to the CDC (Centers for Disease Control and Prevention), in clinical studies, when taken as prescribed, Truvada is at least 92% effective at preventing HIV infection.
In general, the people at high risk of exposure to HIV are men who have sex with men, women who have sex with men whose sexual history is unknown, HIV negative people who have sex with an HIV positive partner, and people who inject drugs intravenously.
To be most effective, Truvada needs to be taken once daily. It is generally very well tolerated by most people. The most common side effects are diarrhea, nausea, fatigue, headache, dizziness, depression, insomnia, abnormal dreams, and rash. Most of these side effects, if they occur, are short-lived. Rarely, Truvada can affect kidney and liver functions and these must be monitored.
Truvada is expensive. However, most insurance companies do cover Truvada for PrEP. Gilead Sciences also has a patient assistance program that can help cover the cost of Truvada. To learn if a person is eligible for this program, call 1-855-330-5479.
Unfortunately, in my experience, people who take Truvada are more likely to practice unsafe sex (bareback sex, sex without a condom) which increases their risk for other sexually transmitted diseases like syphilis, gonorrhea, chlamydia, herpes and genital/rectal warts. In fact, I have made more syphilis diagnoses in the past few months than I have in the previous 15 years! Also, Truvada is NOT 100% effective – people who take it as prescribed can still get HIV.
If you are risk for exposure to HIV, I highly recommend you discuss with us the use of Truvada for PrEP. We will assess your risk, obtain baseline labs, and discuss the risks and benefits to help you make the best decision regarding your health. All of my nurse practitioners as well as myself are capable of discussing this with our patients.
- iPrEX: Grant RM, Lama JR, Anderson PL, et al; iPrEx Study Team. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men . N Engl J Med 2010;363(27):2587-99.
- TDF2: Thigpen MC, Kebaabetswe PM, Paxton LA, et al; TDF2 Study Group. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana . N Engl J Med 2012;367(5):423-34.
- Partners PrEP: Baeten JM, Donnell D, Ndase P, et al; Partners PrEP Study Team. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women . N Engl J Med 2012;367(5):399-410.
- Bangkok Tenofovir Study: Choopanya K, Martin M, Suntharasamai P, et al; Bangkok Tenofovir Study Group . Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial . Lancet 2013;381(9883):2083-90.
Craig A. Stevens, MD