Pre-exposure prophylaxis (also known as PrEP) is an HIV preventative drug. HIV-negative individuals can take this drug daily to limit the probability of contracting HIV from a positive partner. This medication keeps HIV from replicating within the body, acting as an additional protective barrier. When used correctly, PrEP is highly effective at preventing HIV-negative individuals from becoming carriers.
At-risk individuals use pre-exposure prophylaxis in two different ways. PrEP is a once-daily tablet; this medication reduces the risk of transmission by 99% for sexual contact transmission. When used to prevent HIV from injectable drug use, PrEP reduces the risk by more than 70%. Alternatively, PrEP on demand is taken two to twenty-four hours before potential exposure and two days after the incident. This method is only available for limiting the risk through anal sex. This method doesn’t have a high enough concentration to prevent HIV transmission through injectable drug use or frontal sex.
How to Start Taking PrEP
PrEP medications are only available through prescription currently. Any qualified medical professional can prescribe this medication, although they must perform an initial risk assessment and STI panel. Anyone with HIV should not take PrEP as it can cause the drug resistance to HIV medication. All candidates will need to return after the first month to ensure this medication is working well within the body. Patients will need to submit a second STI panel, HIV test, and blood work at this time.
For at-risk individuals wanting to take this medication for longer than one month, additional follow-up appointments will occur every three months. PrEP works well for short-term use (a few weeks, months, or years).
How Does PrEP Work Within the Body?
Individuals taking this medication must remain consistent with their dose. The more sporadically you take this drug, the less efficient it is. As you take this medication, higher concentrations build within the genital region. High concentrations are needed within the genital area to form a protective barrier. These concentrations create a barrier within the body that prevents HIV from replicating within the immune cells.
PrEP works by building fortified walls around the CD4 cells within the body. The walls act as a barrier, barring entry into the T-cells. Without T-cells, HIV can’t replicate and spread infection. In exposure to the virus, the body blocks access and kills the infection. Mucous membranes are the typical entry point for HIV due to the thin area and a minimal protective barrier.
A torn mucous membrane exposes the individual to the virus, allowing easy access to the host. As microtears often occur during sexual activity, access is simplified. Although PrEP acts as a barrier to spreading, using lubrication can lessen the chance of infection through microtears.Additionally, HIV may occur with injection drug use, directly through injection sites (when sharing tools with someone HIV-positive.)
Understanding the Side Effects of PrEP
Only 10% of all PrEP users will experience side effects, most reporting mild symptoms. Users will often experience headaches, nausea, stomach pain, and fatigue. These side effects usually resolve within a few weeks of taking PrEP. Disclosing ongoing side effects or severe symptoms is essential – they could indicate a rare but severe side effect.
Do I need an In-Person Visit to Start or Stop medication?
Although most individuals will visit their healthcare provider in person, there are several options for starting PrEP medications. Teleconferencing and mail-in testing are available for patients wanting a testing kit before starting this medication. To find out which options are available in your area, reach out to your local health department or provider. Many clinics, including sexual health facilities, can provide PrEP prescriptions for qualified populations.
If you’d like to stop taking PrEP, stop taking the daily dosage prescribed. Remember that fewer doses dramatically reduce your level of protection from HIV, potentially exposing you to the virus over time. There are many reasons for stopping pre-exposure prophylaxis. These may include adverse reactions to the drug, lifestyle change, unsafe blood results while taking the medication, or HIV-positive status. Before stopping PrEP, it’s always a good idea to speak with your doctor about alternative HIV prevention. These methods may include barrier contraception (like dental dams or condoms) or PEP for emergency use.