PrEP: HIV Prevention in a Pill?

So what is PrEP? Essentially, it is a pre-exposure treatment (brand name Truvada) containing the medicines tenofovir and emtricitabine, which together help prevent the HIV virus taking hold and spreading. HIV as we know is particularly fucking nasty - destroying the white blood cells known as T-Cells and in turn reprogramming and replicating them, which then (if untreated) leads to severely weakened immune systems for PLWH (People Living with HIV). Without calling upon a science degree - (which I don't have) - in layman terms, the treatment allows for a coating around the cellular structure, which in turn stops the HIV virus from entering the cells and establishing infection.

But how effective is PrEP? The drug, when adequately built up in the users' system (usually after a week of daily doses), reportedly reduces the risk of infection by 92-98% through unprotected sex and for those who inject drugs, by approximately 75%. So - pretty damn effective. Of course, results will vary if the drug is not taken consistently and it protects against only HIV, no other STDs or STIs.

Additionally, for those who are not PrEP recipients but fear they have been exposed to the HIV virus, an alternative is available in the form of ‘PEP’ (Post-Exposure Prophylaxis). Taken within 72 hours of potential exposure, it involves a four week course of 3 anti-HIV drugs and is of course more effective the sooner taken after the risk event. However - whilst PEP is effective in preventing infection, it cannot guarantee with certainty that the individual will not contract the virus.

It should be noted - PrEP by no means guarantees immunity. There have to date been several (albeit rare) cases of PrEP ‘failure’, and these are largely with individuals who have evidenced that they have taken the drug correctly thus have had high adherence. However, the sheer number of individuals taking PrEP (hundreds of thousands worldwide currently) in comparison to the ‘failures’ shows the drug is a crucial tool in preventing HIV. Additionally, these rare cases could well be caused by the transmission of the ‘drug resistant mutation’ of the virus, which of course PrEP will not withstand.

So what are the downsides? As with any drug, there are side effects - studies show users can initially experience nausea and various stomach issues, though these usually abate after consistent use. There is evidence that long term use can aggravate already existing pain in those with weak skeletal structures and there have been rare cases of negative effects on liver function. Whilst these are obviously not ideal, the drug remains life changing for those in sexual relationships with PLWH and those partaking in activities which previously would have presented a high risk of infection.

What next for PrEP? Currently, trials are underway for PrEP implants - much like the birth control implant - which will deliver HIV-preventing medication, thus negating the need for daily pills, for up to a year at a time. Accessibility to PrEP varies massively from country to country, however this year in the US, research-based biopharmaceutical company ‘Gilead Sciences’ announced a yearly donation of 2.4 million bottles of Truvada for uninsured Americans at risk of HIV. This will go a huge way to negate the spread of the virus in the US, which has seen similar numbers of newly reported diagnoses yearly since 2013 and where 15% of those infected are unaware of their HIV status.

Considering taking PrEP? If you believe you are at high risk of being infected with HIV, then speak with your health professional. Usually they will first test you for HIV and other STDs and administer a kidney function test - if PrEP is decided upon as a feasible and necessary option, you will be prescribed Truvada. You will, nonetheless, need to return to your health professional every three months for the same tests - a small price to pay, really, for the peace of mind obtained.