Information for Providers

Who should take PrEP?

PrEP has been shown to help reduce HIV infection risk in multiple clinical trials. The iPrEx trial showed that PrEP reduces the risk of HIV infection among gay and bisexual men and transgender women. Two large trials, Partners PrEP and TDF2, showed that PrEP also reduces the risk of HIV infection among heterosexual men and women. The Bangkok Tenofovir Study demonstrated that PrEP works for people who inject drugs.

Medications Approved for PrEP

Truvada is a combination of two drugs: 300mg of Viread (tenofovir DF) and 200mg of Emtriva (FTC). In July 2012, it was approved as Pre-exposure Prophylaxis (PrEP) and used to prevent HIV among those at high risk for the infection, in conjunction with additional safer-sex behaviors. It was first approved by the U.S. Food and Drug Administration (FDA) as a component of therapy for people living with HIV in August 2004.

What are the side effects of Truvada?

  • Truvada (TDF/FTC) is generally well-tolerated.
  • Rare, but severe adverse reactions can include: Lactic acidosis, severe liver problems, and exacerbation of hepatitis B for those with HBV infection who suddenly stop TDF/FTC. Consider using an anti-HBV if stopping treatment.
  • Common adverse effects include: Headache, diarrhea, flatulence and nausea.
  • Long-term effects of TDF/FTC include renal insufficiency and decreased bone mineral density.

How Effective is PrEP?

  • The first randomised controlled trial producing statistically meaningful results of PrEP was announced on November, 23 2010. The iPrEx (Pre-exposure Prophylaxis Initiative) trial found that the HIV infection rate in HIV-negative gay men who were given a daily pill containing two HIV drugs was reduced by 44%, compared with men given a placebo. The efficacy in subjects who, by self-report and pill count, took the drugs more than 90% of the time was 73%.
  • The Partners Demonstration Project among discordant heterosexual couples (where one partner is HIV-positive and one is not) in Kenya and Uganda showed that a program that delivers both PrEP for HIV-negative partners and/or antiretroviral treatment (ART) for HIV-positive partners reduced the risk of HIV infection by 96%. These results highlight the potential impact of combining PrEP and ARV treatment to slow the HIV epidemic.
  • The PROUD Study among high risk men who have sex with men (MSM) in the UK showed that daily oral PrEP reduced the risk of HIV infection by 86% when delivered in existing public health clinics.
  • The French study, IPERGAY, was the first to examine the efficacy of “event-driven” PrEP. In this case, a three-day dosing strategy involving four pills around the time of sex. This was among high risk MSM who reported frequent sex. Overall, PrEP reduced the risk of HIV infection by 86% in the trial. Based on reported pill use by men in the trial, the regimen that most participants took amounted to at least four doses a week. Previous studies of daily oral PrEP have shown that this may be enough to be protective. However, it is not clear how well the event-driven regimen would work for men who have less frequent sex than the men in the trial. PrEP “on-demand” is not FDA approved at present.

Guidelines for Prescribing PrEP

Medications Approved for PEP

Guidelines for non-occupational post exposure prophylaxis.

A guide to discussing sexual health with MSM

References:

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  2. Centers for Disease Control and Prevention. PEP. Retrieved from: http://www.cdc.gov/hiv/basics/pep.html

  3. Centers for Disease Control and Prevention. Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States. Retrieved from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm

  4. Centers for Disease Control and Prevention. PrEP. Retrieved from: http://www.cdc.gov/hiv/basics/prep.html

  5. Choopanya, K., Martin, M., Suntharasamai, P., Sangkum, U., Mock, P. A., Leethochawalit, M., . . . Bangkok Tenofovir Study Group. (2013). Antiretroviral prophylaxis for HIV infection in injecting drug users in bangkok, thailand (the bangkok tenofovir study): A randomised, double-blind, placebo-controlled phase 3 trial. Lancet, 381(9883), 2083-2090. doi:10.1016/S0140-6736(13)61127-7 [doi]

  6. Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., . . . Glidden, D. V. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med, 363(27), 2587-2599. doi:10.1056/NEJMoa1011205

  7. McCormack, S. (February 2015). PROUD study results. Retrieved from http://www.proud.mrc.ac.uk/news/study_results.aspx

  8. Newman, E. (2015). On demand antiretroviral pre-exposure prophylaxis for HIV infection in men who have sex with men (IPERGAY). Retrieved from http://betablog.org/demand-prep-shows-high-efficacy-ipergay-trial/

  9. New York City Department of Health and Mental Hygiene. PrEP & PEP: New ways to prevent HIV. Retrieved from: http://www.nyc.gov/html/doh/html/living/prep-pep.shtml

  10. POZ and AIDSmeds Editorial Team. (January 2012). Treatments for HIV/AIDS. Retrieved from http://www.aidsmeds.com/list.shtml

  11. San Francisco Aids Foundation. The basics. Retreived from: http://men.prepfacts.org/the-basics/

  12. San Francisco Aids Foundation. The questions about PrEP. Retreived from: http://men.prepfacts.org/the-questions/

  13. Thigpen, M. C., Kebaabetswe, P. M., Paxton, L. A., Smith, D. K., Rose, C. E., Segolodi, T. M., . . . Brooks, J. T. (2012). Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in botswana. N Engl J Med, 367(5), 423-434. doi:10.1056/NEJMoa1110711

  14. U.S. Department of Health and Human Services. (2014). Side Effects of HIV Medicines. Retrieved from: http://aidsinfo.nih.gov/education-materials/fact-sheets/22/63/hiv-medici...

  15. U.S. Department of Health and Human Services. Post-Exposure Prophylaxis. Retrieved from: https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/post-ex...

  16. U.S. Department of Health and Human Services. Pre-exposure Prophylaxis. Retrieved from: https://www.aids.gov/hiv-aids-basics/prevention/reduce-your-risk/pre-exp...