Is PrEP right for you?

Learn about Pre-Exposure Prophylaxis for HIV

I am pleased to have an opportunity to reach out to you about a topic that I have a great interest in, Pre-Exposure Prophylaxis (PrEP) for HIV. I am hoping to share some information with you on PrEP and answer some questions that I am asked frequently.

What is PrEP? PrEP is pre-exposure prophylaxis for Human Immunodeficiency Virus (HIV), the virus responsible for Acquired Immunodeficiency Syndrome (AIDS). In the simplest form, PrEP is medication taken prior to potential or high-risk exposure to HIV to decrease the chance of HIV transmission. It is important to know that PrEP is not 100% effective, however in recent studies it has been shown to be effective up to 90% and even higher when used properly and in combination with other exposure prophylaxis measures. PrEP is not to be confused with PEP which is Post-Exposure Prophylaxis, meaning medication taken after a potential or known exposure to body fluids that contain HIV.

In the United States, one drug is currently FDA approved for PrEP. That is a combination antiretroviral drug known as Truvada®. The components of this drug are Tenofovir Disoproxil Fumarate and Emtricitabine. It is a combination, fixed-dosage medication that is taken on a daily basis.

Some common questions that I am asked include: Who is PrEP for? Is PrEP something I should consider?

The way I approach this subject is to discuss past, current and perhaps foreseen sexual relationships moving forward. By Center of Disease Control and Prevention (CDC) guidelines, PrEP should be considered in the following situations:

People who are HIV negative and are at substantial risk for HIV infection are defined by the CDC as:

• An ongoing relationship with an HIV positive partner
• Not in a mutual monogamous relationship with a partner who recently tested HIV negative
• A gay or bisexual man who has had unprotected anal sex
• A gay or bisexual man who has been diagnosed with a STD in the past 6 months
• Heterosexual male or female who is having unprotected sex with partner(s) of unknown HIV status and who at substantial risk of HIV infection
• Those who inject illicit drugs, share needles or have been in a drug treatment program for injection drug use in the past 6 months
• Heterosexual couples in which one partner is HIV positive, the other HIV negative and there is plan for conception and pregnancy.

Each individual and situation is different, but if the guidelines above seem to fit a scenario you may be in, it may be worth a conversation with a PrEP-versed healthcare provider to see if PrEP may have a place in your life.

Are there side effects of PrEP?

Like all medications, they are potential side effects that need to be discussed and monitored regularly with a healthcare provider. This includes monitoring kidney function, screening for HIV infection and other sexually transmitted diseases (STDs), and bone density depending on how long the medication is used for.

It is important again to stress that PrEP is not 100% effective for prevention of HIV and should still be used with other means of protection - condoms. In the last five years, the United States has seen an increasing rise in other sexually transmitted diseases including chlamydia, gonorrhea, and syphilis. PrEP does not provide protection against chlamydia, gonorrhea, or syphilis.

If you are looking for additional resources on PrEP, here are a few websites to get you started:

Center for Disease Control: www.cdc.gov/hiv/risk/prep

World Health Organization: http://www.who.int/hiv/topics/prep

Gilead (Manufacturer of Truvada®): https://www.truvada.com/

William Chasanov, DO, MBA, is a Board Certified Infectious Disease and Internal Medicine physician with Beebe Infectious Disease. Learn more about Dr. Chasanov: www.beebehealthcare.org/doctors/william-chasanov-do.