The following information was written by and is presented in partnership with the Tennessee Department of Health:
World AIDS Day was Dec 1, a day when we remember lives lost to this global pandemic and acknowledge the many lives which continue to be affected by HIV. Thankfully, in recent years we have much to be grateful for when considering options for HIV prevention. In addition to external and internal condoms (www.freecondomstn.org), we now have biomedical HIV prevention options which include PrEP, an antiretroviral medication which reduces the chance of contracting HIV by 99% when taken as prescribed, and PEP, a 28-day antiretroviral treatment for people who may have been exposed to HIV within the previous 72 hours. Below you will find the answers to several important questions about these HIV prevention options.
PrEP (pre-exposure prophylaxis)
Who could benefit from taking PrEP? Anyone who does not have HIV and who may be likely to encounter HIV. This could be someone who is sexually active and doesn’t use condoms consistently or is not in a mutually monogamous relationship (i.e. both partners only have sex with each other, and no one else), someone whose partner is living with HIV, or someone who shares injection equipment with other people when using drugs or silicone, as well as anyone who feels that PrEP will allow them to take more control of their sexual health and reduce their anxiety about HIV.
How does PrEP work? When HIV enters the body, it attacks our immune system through our CD4 T cells, using those cells to make more copies of the virus. PrEP stops the virus from making copies of itself inside the CD4 T cells, preventing HIV from taking hold and stopping it from reproducing.
How do I take PrEP? PrEP is currently approved by the FDA as a once-daily pill. It should be taken about the same time of day, every day, and can be taken with or without food.
Is PrEP safe? Yes! The medications used for PrEP have been around for 20 years as antiretrovirals used to treat people living with HIV, so we have many years of data to tell us about how PrEP affects our bodies. A very small fraction of patients may have a decrease in kidney function or an increase in bone density loss, but both side effects are reversible when PrEP is stopped. Your doctor will monitor kidney function through labs and determine if monitoring is needed for bone density, as well.
Which medicines can be used for PrEP? The first PrEP regimen approved by the FDA was Truvada, in 2012, followed by Descovy, in 2019. While both daily medications work extremely well, there are some differences between the two. First, Truvada is approved for use in cisgender and transgender individuals of all genders, while Descovy is currently only approved for use as PrEP in people assigned male at birth. (Studies are under way to expand approval to include people having receptive vaginal sex.) Second, while Truvada should only be used by people with normal kidney function, Descovy may be used by some people with decreased kidney function. Additionally, as of this fall, a generic version of Truvada is also available. Finally, recent studies have shown a long-acting injectable medication, Cabotegravir, to be another highly effective option which may soon be available for use as PrEP.
Does PrEP have side effects? As with any medication, some people experience mild side effects when they first start taking PrEP, often called “start-up syndrome.” These can include nausea, dizziness, lack of appetite and headache. Only about 20% of patients will have any side effects, and they usually stop within two weeks to a month after beginning PrEP.
Is PrEP safe to use with gender-affirming hormones? Yes! Although there is limited research on trans folks who use PrEP and gender-affirming hormones, what data that does exist indicates that PrEP does not affect hormones for either trans men or trans women, and hormones do not significantly affect PrEP, either.
What do I have to do to get PrEP? In order to get PrEP, you’ll need to see a provider, either in person or virtually, for an initial visit and follow-up appointments every 3 months. At those appointments you’ll also do important lab work, including HIV and STI (sexually transmitted infections), kidney function (creatinine), pregnancy (if applicable), and every six months to one year, Hepatitis B and C testing (depending on need).
Once I start PrEP, do I have to stay on it forever? No way! PrEP is a medication intended to be used when you need it and stopped when you don’t. We like to think about “seasons of pleasure,” when you may have more sexual or drug use encounters in which you could be exposed to HIV. During these times you may choose to use PrEP to protect yourself from HIV. If your likelihood of being exposed to HIV changes, you may choose to stop using PrEP. However, it is important to remember to discuss stopping PrEP with your provider and before starting it again, even if you already have your prescription filled. This is because you’ll need new labs drawn to be sure it’s still safe for you to take PrEP.
Also, keep in mind that it takes 7 days for PrEP to reach maximum efficacy for anal sex and 21 days to reach maximum efficacy for vaginal sex or blood exchange, so if you have a short window of time when you think you don’t need PrEP, consider continuing to use it so that you’re protected when you need it down the road!
PEP (post-exposure prophylaxis)
When should I seek PEP (post-exposure prophylaxis)? PEP should be used in cases when there is a strong likelihood that someone who does not have HIV has been exposed to HIV within the last 72 hours, which could include not knowing the HIV status of a sex partner with whom you had condomless sex (anal or penile-vaginal), having condomless sex with someone who is living with HIV and who is not virally suppressed (undetectable), or sharing syringes or other works with someone with whom you used drugs or injected silicone, and whose HIV status you do not know, or who is living with HIV. PEP is for emergency situations and not a substitute for regular use of HIV prevention methods such as using condoms, taking PrEP or not sharing needles or works.
How do I take PEP? PEP is usually prescribed as a combination of three antiretroviral medications, taken once or twice daily for 28 days. There are several different combinations of medications which can be used for PEP, depending on the patient’s needs.
How does PEP work? PEP works by preventing HIV from replicating in the body after a recent exposure.
Is PEP safe? Yes! PEP regimens consist of several anti-retroviral medications which have been used to treat people living with HIV for many years, so we have a lot of data on how these medicines affect the body. There is more than one PEP regimen, so your doctor will have options to consider if you have a specific medical concern.
Does PEP have side effects? Some people experience side effects such as fatigue, dizziness, nausea, flatulence, and headache, although most side effects go away or become manageable within a few days or weeks. Some of these side effects can be managed with over the counter or prescription medications, as well.
PrEP and PEP Access
How do I get PrEP or PEP in Tennessee? Many, but not all healthcare providers in Tennessee will prescribe PrEP and PEP. First go to www.GetPrEPTN.com to learn more about PrEP and PEP, then find a navigator to help you walk through the process and to find a doctor to prescribe the medication. This website is available in Spanish, as well.
How much do PrEP and PEP cost? You may have heard that PrEP and PEP are expensive. Thankfully there are a number of programs that can help to pay for prescriptions or prescription copays, and some even cover labs and appointment fees. Don’t know where to start? Don’t worry! Our navigators are trained to help you find the right program, fill out the paperwork, and make sure that PrEP or PEP is accessible to anyone who needs it! You can find a navigator here: https://getpreptn.com/get-prep/. Even if you don’t live nearby, navigators can help you remotely via phone, text, or video chat- whatever works for you!
For more information about PrEP and PEP, check out the following resources: