How to Prevent HIV With a Once-per-Day Pill

PrEP, an acronym for "Pre-Exposure Prophylaxis," is a form of HIV prevention where someone takes medicine, which is normally used to treat HIV, in advance of a possible HIV-exposure in order to prevent them from acquiring the HIV virus. Basically, you take one pill every day, and your risk of acquiring HIV is reduced by over 99 percent when used as directed.

In the United States, there is only one drug currently approved for PrEP, called Truvada and manufactured by Gilead. This drug has been used for a very long time as part of treatments for people living with HIV, but it wasn't until 2012 that the FDA approved Truvada to prevent HIV in people who are currently HIV negative.

Though Truvada is generally well-tolerated by most people, it can cause side-effects in some individuals. It is also important to confirm that you are HIV-negative before you start taking Truvada, because taking Truvada alone if you are HIV-positive can make the virus more difficult to treat. For these reasons, Truvada is available by prescription only.

Although condoms are effective at preventing the spread of HIV, they are not well-tolerated by everyone. Also, like a seat belt, they only work if you are wearing one. Sometimes people forget to use a condom in the heat of the moment, sometimes condoms break, and sometimes people use condoms incorrectly. In other instances, sex workers, people who are sexually assaulted, or those who are in an abusive relationship, are not in a position to negotiate condom use.

There have been countless stories of people in what they thought were monogamous relationships contracting a sexually-transmitted infection from an unfaithful partner. For all of these reasons and more, PrEP is an important tool in the HIV-prevention toolbox. PrEP allows an individual to take their HIV-prevention into their own hands, without having to rely on information from or behavior by anybody else.

As noted before, PrEP is only available by prescription, so you'll need to talk to your doctor to get started. Any doctor who can legally write a prescription can prescribe you Truvada as PrEP, although some doctors may still be unfamiliar with the drug since the indication for its use as an HIV-prevention measure is still somewhat new. You can talk to your primary care doctor about a prescription, or you can see a specialist. In most areas of the country, you can get PrEP from community health clinics and organizations like Planned Parenthood as well. A Google search for "HIV prep + (your city name)" often yields plenty of results if you cannot talk to your own doctor for whatever reason.

In order to be a good candidate for PrEP, you must currently be HIV-negative, and at a high-risk of acquiring HIV. Your doctor can help you determine if PrEP is right for you. Your doctor will need to do some blood work to get you started on Truvada, including an HIV-test and also a kidney-function test, since Truvada can cause kidney problems in very rare cases.

Once your bloodwork comes back and you have the all clear, you can get your prescription for Truvada filled. Truvada is an expensive drug (often $1200/month or more), but luckily it is covered by most private and government-run health insurance plans. If you have high co-pays for your Truvada prescription, you can get a free co-pay assistance card from Gilead which can cover up to $3600 worth of co-pays per year. (It is also possible to import generic Truvada from overseas if cost is still an issue, but I won't cover that topic here.)

Once you have your Truvada prescription, you just need to take your pill once a day. The drug takes a few days to reach peak concentrations in your body, and most doctors agree that peak HIV protection is achieved after 7 days of taking the drug.

Current guidelines call for follow-up visits with your doctor every 3 months, during which you may be tested for HIV, other sexually-transmitted infections, or have some of your original lab work repeated to see how your body is doing.

You bet it does! But you have to take it regularly for it to work. In PrEP studies, people who had blood-levels of Truvada that indicated they were taking their medication daily had NO NEW HIV INFECTIONS! Another good thing about Truvada is that it stays around in your body for awhile, so even if you miss a dose, you still have a very high degree of HIV protection.

PrEP is recommended to be used in conjunction with other safer sex choices, like using condoms and limiting your number of sexual partners, but the good news is that PrEP works to protect you from HIV, regardless of anything else you may do.

It is important to note that Truvada as PrEP only protects you from acquiring HIV, and it does not protect against other sexually-transmitted infections. Luckily, with the regular doctors visits and testing required as a part of PrEP, and problems that do arise are likely to be detected and treated much earlier than they would have been without this regular testing.

This article is intended just as a jumping off point for people who may not know about PrEP as an HIV-prevention option. Talking to your doctor or clinician is a great place to start, since you'll need a prescription to begin taking PrEP. There is a wonderful Facebook FAQ and group page where you can go to read more information about PrEP, and get specific questions answered by a large community of people knowledgeable about the subject. Finally, you can visit Gilead's Truvada website for prescribing and side-effect information, along with information you can provide to your doctor.

HIV-prevention is an important and personal decision, so make sure you take the time to research your options and figure out what is best for you.