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What to Know About PrEP

Pre-exposure prophylaxis (PrEP) is a highly effective tool to prevent HIV infection. 

Published
By
Rin Swann

By the end of 2023, over 39 million people worldwide were living with HIV. While HIV infection can be managed with medications, there is no vaccination or cure for the virus, which spreads via bodily fluids. 

PrEP (pre-exposure prophylaxis) is an effective way to reduce the risk of contracting HIV through sexual activity or injection drug use. Currently, there are two oral forms that are taken daily, Truvada and Descovy. Apretude, an injectable form, is administered every other month by a healthcare provider. All forms work by interfering with HIV’s ability to replicate within the human body. 

Who should consider taking PrEP?

PrEP is recommended for people who don’t have HIV but are at risk of exposure. Examples include people who:

  • Have a partner living with HIV
  • Frequently change partners
  • Have sex with people with unknown HIV status
  • Inject drugs
  • Work in sex industries
  • Feel that they may be at risk 

It is important to be tested for HIV before taking any form of PrEP. While the medications used in PrEP are also used in HIV treatment, they are not enough to suppress the virus. If PrEP is given to someone who has HIV, the virus may replicate and develop resistance to those medications. 

How effective is PrEP?

When taken as prescribed, PrEP reduces the risk of acquiring HIV infection through sexual activity by up to 99% and, for those who inject drugs, at least 74%. 

Medication adherence is key to maintaining high levels of protection, especially for those who take oral PrEP. 

“If you take your PrEP every day and don’t miss doses, then it’s highly effective,” says Matthew Hamill, MBChB, PhD, MPH, an associate professor at the Johns Hopkins School of Medicine and in Population, Family and Reproductive Health at the Bloomberg School.

What kind of PrEP should I take? 

Truvada, the first approved form of PrEP, is suitable for men, women, cisgender, and transgender patients. Truvada contains emtricitabine and tenofovir disoproxil fumarate. The latter is an older form of tenofovir that has been associated with possible kidney and bone side effects, though it is generally tolerated well.

Descovy, on the other hand, uses a newer form of tenofovir, tenofovir alafenamide, that is gentler on the kidneys. Descovy is recommended for people assigned male at birth. 

Apretude, the injectable version of PrEP, is suitable for all patients and is safe for those with kidney concerns. 

If someone is at risk for HIV infection, “then there is a method of PrEP that should be both acceptable, safe, and efficacious for them,” says Hamill.

How do I access PrEP?

The best way to access PrEP is by talking to your provider. Hamill recommends having a preliminary conversation to learn more about what PrEP is, whether it is right for you, and which form is best for you. 

“Sometimes potential PrEP users feel a little nervous about approaching their provider because it means they need to talk about sex,” Hamill says. “But for the vast majority of people, it is a very straightforward intervention.”

Will my insurance cover PrEP?

PrEP is currently covered under the Affordable Care Act (ACA), meaning most insurance providers will cover PrEP at no cost. For those who are uninsured, patient assistance programs may provide PrEP at little to no cost. 

However, a recent lawsuit out of Texas, Braidwood Management Inc. v. Becerra, has challenged the no-cost coverage of PrEP and other preventive services under the ACA. The Supreme Court has agreed to take up the case, which has the potential to eliminate ACA’s requirement for insurers and employers to cover preventive services.

The CDC’s Paying for PrEP site can help those interested in PrEP find methods to afford it.

Do I still need to use condoms if I’m using PrEP? 

While PrEP protects against HIV infection, it does not prevent chlamydia, gonorrhea, syphilis, hepatitis C, or other sexually transmitted infections. These infections can be spread through genital sex, anal sex, and oral sex, so it is important to use protection and discuss concerns with your provider. 

“We don’t want to give people who are taking [PrEP] a false sense of security about other STIs,” Hamill says. “Think about condom use, whether that's male or female condoms.” 

What if I might have been exposed to HIV before taking PrEP for the recommended amount of time? 

Oral PrEP takes seven days of consistent use to reach maximum protection against contracting HIV through anal sex, and 21 days for vaginal sex or injection drug use. 

If you believe you may have been exposed before using PrEP for the recommended amount of time, you may be at risk of contracting HIV and should talk to your doctor about next steps. There are preventative measures available if you have been exposed to HIV in the past 72 hours (called PEP).

 

Rin Swann is a marketing and communications specialist in the Office of External Affairs at the Johns Hopkins Bloomberg School of Public Health.

 

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