Pre-Exposure Prophylaxis

Pre-Exposure Prophylaxis (PrEP) is one of the newest and most effective ways of preventing HIV, and there has been a lot of hype, excitement, and misinformation surrounding the idea of pre-exposure prophylaxis. But what really is PrEP? Who can take the pill? What are the risks, and what are the benefits?

What exactly is PrEP? To understand what PrEP is, it is important to understand what Pre-Exposure Prophylaxis means. Pre-Exposure, in this case, meaning before one is exposed to the HIV infection. Prophylaxis means to prevent the spread of a disease/infection. So in this case Pre-Exposure Prophylaxis means, to prevent the PrEP Infographicspread of HIV, before one is exposed to it. The PrEP pill is being prescribed under the brand name Truvada.  Truvada is used in two different ways: 1) To treat HIV, in combination with other medications, in those over the age of 12, and 2) To reduce the risk of contracting HIV in at risk adults.  It is important to understand that Truvada is not a vaccine, but instead works by blocking HIV replication, thus preventing the establishment of infection in the body of HIV negative individuals. Studies have shown that the use of PrEP can decrease an individual’s risk of contracting HIV by up to 99%.

But who can take Truvada for PrEP? According to the CDC, ‘at-risk’ people include “HIV-negative men who have sex with men and who are at high risk of getting infected with HIV through sex, and male-female sex partners when one partner has HIV and the other does not.” There are other situations that may make one at-risk, such as injection drug use, sex work, or having recently been diagnosed with a sexually transmitted infection. At the moment, Truvada for PrEP is only recommended for those 18 years of age or older, and that are determined to be at-risk by their doctor. You must also be HIV-negative to start a Truvada for PrEP plan. Once you have started taking PrEP you must commit to HIV, STD, as well as other tests and doctor visits every three months, to ensure you maintain your HIV negative status. The Center for Disease Control “recommends that PrEP be considered for people who are HIV-negative and at substantial risk for HIV.” (PrEP 101) The World Health Organization “strongly recommends men who have sex with men consider taking antiretroviral medicines as an additional method of preventing HIV infection (pre-exposure prophylaxis) alongside the use of condoms.” (WHO: People Most at Risk)

What are the Risks of PrEP? Many opponents of PrEP are expressing their concerns about the risks associated with taking Truvada for PrEP. A primary concern is the risk developing a resistance to Truvada, an important drug used to treat HIV; however, the iPrex study on PrEP found little to no evidence of resistance when the drug was taking as advised. A variety of side effects are possible, so be sure to discuss any potential
side effects with your doctor when deciding whether PrEP is right for you. PrEP also has a variety of benefits as well. When taking correctly and daily as prescribed, PrEP has been shown to reduce the risk of contracting HIV by up to 99%. These rates are extraordinary, but PrEP should still be used with safe sex practices, as it does not offer any protection against other sexually transmitted infections such as syphilis or gonorrhea.

AIDS Resource Center Ohio (ARC Ohio) and The Ohio AIDS Coalition (OAC) have been working diligently to promote education, research, and the use of Truvada for PrEP. Both organizations believe that with proper education, medical supervision, and the addition of safe sex practices, PrEP could be the next major step in the fight against HIV.

 

2014 International AIDS Conference Recap

The 2014 International AIDS Conference wrapped up in July in Melbourne, Australia. The week-long symposium is a gathering of the best and brightest in the AIDS field from across the world. Thousands of researchers, activists, and, AIDS professionals gathered to discuss the latest in HIV treatment, prevention, and policy. This year’s conference hot topics included PrEP and Hepatitis C, both of which OAC have been focusing diligently on.

A major topic of conversation was PrEP, one of the newest HIV prevention strategies. This pill, which OAC has been education Ohioans and promoting on behalf of, is a viable option for protection against HIV. Numerous studies about the effectiveness of PrEP were presented at the conference. iPrex discussed the importance of medication adherence while on PrEP.  The research found that while taking Truvada four or more days a week on a regular basis, men and transgender women who have sex with men were 100% protected against HIV. This same study, however, found that this strict adherence to the pill only occurred 33% of the time.  This study is the first to show results from PrEP in a real-world situation, without a randomized controlled trial where some participants received a placebo. PrEP works.  Adherence is key.

PrEP is an exciting new tool in the HIV prevention toolbox that has the potential to play a huge role within the AIDS epidemic.   The Ohio Aids Coalition will be co-hosting a community conversation on PrEP on September 24th from 6:30 to 8:30 at the Columbus Public Health Building. Professionals, consumers, and activists will be in attendance.  The program will have a brief PrEP 101, an expert panel encompassing all sides of the PrEP world to offer perspective and answer questions, and an interactive component that will engage folks in a meaningful dialogue about negotiating safe(r) sex practices in an era of PrEP, and a discussion on what PrEP means for the future.  Email Zach Reau at Reau@ohioaidscoalition.org for more information or to RSVP!

Another important topic that was routinely brought up at the conference was that of Hepatitis C, a disease that is exceptionally prevalent in the HIV community. Nationally, 25% of people with HIV are co-infected with Hepatitis C. Hepatitis C is one of the leading causes of non-HIV related causes of death for persons living with HIV. This topic was met with both a positive and negative outlook. Research studies presented at the conference showed that the drugs Sovaldi and Ribavirin are known to cure those infected with both HIV and specific strains of Hepatitis C. In a study containing 274 participants, the cure rate ranged between 83 and 91 percent. Previous Hepatitis C treatments were nowhere near as successful and are associated with some pretty bad side effects.  Sovaldi has also been shown to be successful in persons who are HIV positive.  The research was not met with complete positivity though; the Fair Pricing Coalition (FPC) as well as other activists protested the prices set on Sovaldi. Sovaldi costs about $1,000 a pill, making treatment cost between $84,000 and $168,000 for 12 weeks and six months of treatment, respectively. The FPC states that Gilead, the company producing Sovaldi, is unfairly marketing the drug at too high of a price, making it unavailable to the majority of people suffering from Hepatitis C. Gilead is still standing strong behind their prices and Sovaldi. Gregg Alton, a Gilead Vice President said “It is a fantastic drug. It’s really changing the landscape of Hepatitis C and the ability to treat hepatitis C, from a largely untreatable disease to one we can cure with a more than 90 percent rate.” Activists are stating that they don’t believe Gilead shouldn’t be making a profit, but they are simply out of touch with reality. There are currently some promising Hepatitis C drugs coming through the pipeline.  Hopefully the increased competition will help lower Sovaldi prices to reasonable rates.

The 2014 International AIDS conference brought up a variety of interesting points on the fight against HIV/AIDS. Groundbreaking research in the HIV field was unveiled to allow for the medical advancement of treating HIV, social activism played its part in fighting for patients’ rights, and the world learned a little bit more about the needs of the HIV community. Overall, the conference was a huge success and brought to light the many needs of the HIV society. We have come a long way in the past 33 years but we still have a long way to go.

The next conference is set to take place next July in Vancouver, Canada. More information on the conference can be found at IAS2015.org.