From the Guidelines
Yes, there is medicine to prevent HIV infection, known as pre-exposure prophylaxis (PrEP), which can reduce the risk of getting HIV from sex by about 99% when taken consistently, as recommended by the 2018 guidelines of the International Antiviral Society-USA panel 1.
Key Points to Consider
- The most common PrEP medications are Truvada (containing emtricitabine and tenofovir disoproxil fumarate) and Descovy (containing emtricitabine and tenofovir alafenamide), taken as one pill daily.
- Another option is Apretude (cabotegravir), given as an injection every two months after initial doses.
- To start PrEP, you need to test negative for HIV and have normal kidney function.
- Regular follow-up visits every 3 months are necessary for HIV testing and monitoring for side effects, which may include nausea, headaches, or kidney issues in rare cases.
- PrEP works by preventing HIV from establishing infection in the body, but it doesn't protect against other sexually transmitted infections, so using condoms is still recommended.
- PrEP must be prescribed by a healthcare provider and taken exactly as directed to be effective.
Important Considerations
- PrEP is recommended for populations with an HIV incidence above 2% per year 1.
- Daily TDF/emtricitabine is recommended for persons at risk of HIV through sexual exposure (evidence rating AIa) and for people who inject drugs (evidence rating BIa) 1.
- TDF-based PrEP is not recommended in persons with creatinine clearance below 60 mL/min/1.73m2 (evidence rating AIIa) 1.
From the Research
HIV Pre-Exposure Prophylaxis (PrEP) Medications
There are several medications available to prevent HIV infection, including:
- Emtricitabine and tenofovir disoproxil fumarate (TDF) 2
- Emtricitabine and tenofovir alafenamide (TAF) 3, 4, 5
Efficacy of PrEP Medications
Studies have shown that:
- TDF/emtricitabine reduces HIV acquisition by more than 90% in men who have sex with men, high-risk heterosexuals, and injection drug users who share injection equipment 2
- TAF/emtricitabine is non-inferior to TDF/emtricitabine for HIV prevention 3, 4
- TAF/emtricitabine has more favorable effects on bone mineral density and renal biomarkers than TDF/emtricitabine 3, 4, 5
Safety and Tolerability of PrEP Medications
Research has found that:
- TDF/emtricitabine is safe and well-tolerated, with only 2% of people discontinuing PrEP due to adverse effects 2
- TAF/emtricitabine is also safe and well-tolerated, with a low number of participants reporting adverse events that led to discontinuation of the study drug 3, 4, 5
Adherence and Resistance
Studies have shown that:
- Adherence to PrEP is crucial for its effectiveness, with high adherence resulting in significant reductions in HIV incidence 2, 6
- Resistance to TDF/emtricitabine is rare, but can occur when PrEP is inadvertently prescribed to individuals with undiagnosed acute HIV infection 2
- TAF/emtricitabine has been shown to have a low risk of resistance, even in cases of non-adherence 5
On-Demand PrEP
Research has found that:
- On-demand PrEP with TDF/emtricitabine is a valid alternative to daily PrEP for men who have sex with men, providing greater choice in HIV prevention 6