December 1st is World AIDS Day, a day of remembrance and awareness of the AIDS pandemic that affected millions of Americans and people worldwide. The AIDS pandemic was caused by the rapid spreading of HIV infection, which causes acquired immunodeficiency syndrome, known as AIDS. HIV and AIDS are incurable diseases that, once acquired, can only be mitigated through medicines and holistic health. There are, however, preventative measures that exist to ensure individuals at risk of contracting the infection are protected. Protected sex, such as using a condom during sex, is highly effective at protecting individuals because the HIV spreads through blood, semen, and vaginal fluids. However, certain medications such as PrEP and PEP have been developed to help protect individuals from acquiring the virus if they come into contact with it. Keep reading to learn more about PrEP, PEP, and other preventative measures from our Adolescent Medicine residents at the Ybor Youth Clinic.
Q: What is the difference between PrEP and PEP?
A: PrEP and PEP are for people who do not have HIV but who are at risk for getting HIV from sex or injection drug use. Both PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) are methods to prevent HIV infection. Still, as the names imply, one main difference is in the timing of when the medication is taken. The other major difference is the medication(s) used for each method. Both methods have been proven to be effective in decreasing the risk of HIV infection, depending on whether an individual has been exposed to HIV or not. Neither method prevents other types of sexually transmitted infections, like gonorrhea, chlamydia, syphilis, etc., so it is still important to use other barrier forms of contraception when taking PrEP or PEP. It is also important to note that these are not treatment options for HIV and should not be taken by people who have tested positive for HIV.
PrEP:
Daily pill, “on-demand” pills (2-1-1), or every 2 months injection, taken before potential HIV exposure (see next question for more information about these different options).
98-99% effective in preventing HIV transmission from sex when taken as prescribed.
Talk with your healthcare provider about PrEP if you are HIV-negative but are at elevated risk of exposure to HIV. This includes people who have had anal or vaginal sex in the past 6 months, and: an HIV-positive sexual partner, have sex with partners of unknown HIV status and do not consistently use condoms, or have been diagnosed with another sexually transmitted infection. It is also recommended for people who inject drugs and have an injection partner with HIV or who share needles.
PEP:
Combination of 3 oral medications taken for 28 days (about 4 weeks) for emergencies after potential exposure to HIV.
Must be taken within 72 hours (3 days) of exposure to HIV to be effective.
Reduces the risk of HIV infection by 80% when taken as prescribed.
Talk with your healthcare provider about PEP if you are HIV-negative but have had an exposure to HIV within the last 72 hours (about 6 days).
Q: Are there different forms of PrEP, and which one is best for me?
A: Yes! Currently, there are two oral medication options and one injectable medication approved by the FDA for PrEP, depending on the patient. All options have been approved for people 12 years and older weighing more than 77 lbs., and are highly effective in reducing the risk of getting HIV from sex (98-99%). One of the oral medications is about 74% effective in reducing the risk of HIV from injection drug use.
The two available oral medication options for PrEP are Truvada (emtricitabine/tenofovir disoproxil fumarate) and Descovy (emtricitabine/tenofovir alafenamide). Both contain similar active ingredients. However, Descovy is not approved for people assigned female at birth who are at risk of getting HIV from vaginal sex or for people who inject drugs because its effectiveness has not been studied. Truvada is approved for all people at risk of HIV infection from sex or IV drug use. There are two dosing schedules approved:
For all people with frequent potential exposure to HIV and people participating in vaginal receptive intercourse, these medications must be taken every single day, or they are not as effective.
For certain people who require HIV prevention medication infrequently, there is an “on-demand” dosing option using Truvada, called PrEP 2-1-1. This regimen has only been studied on cis-gender males and transgender women who participate in receptive or incentive anal sex and has not yet been approved for cis-gender women or transgender men. Rather than taking the medication every single day, a person at risk of HIV transmission can take 2 pills between 2-24 hours before a sexual encounter, followed by 1 pill 24 hours later, and 1 more pill 24 hours after the second dose (hence, 2-1-1). This option offers much more flexibility for patients than daily medication. However, it requires a person to have enough planning in advance to take the medication 2-24 hours before a sexual encounter and to remember to take subsequent doses. This regimen is not approved for people at risk of HIV infection through IV drug use.
There is currently only one long-acting injectable medication, recently approved by the FDA in 2021 for PrEP, called Apretude (cabotegravir). When starting this medication, patients get two initial injections one month apart, then every two months after that. This may be a better option for people who find it hard to remember to take a daily medication.; However, as of now, the drug cannot be self-administered and requires a visit to your health care provider every 2 months. This medication is not approved for people at risk of HIV infection through IV drug use.
Q: What else can I do to prevent myself from getting HIV and other STIs (besides taking PrEP)?
A: There are several other steps you can take to protect yourself from getting HIV and other STIs, besides taking PrEP or in addition to PrEP. Using condoms and other barrier contraceptives like dental dams every time you have sex, for the entire duration of sexual contact, significantly decreases the risk of contracting HIV or other STIs, since these infections are spread through bodily fluids or skin-to-skin contact with the infected part of a person’s body during vaginal, oral, and anal sex. Limiting your number of sexual partners and talking with your partners about their sexual behaviors, as well as asking your partner to get tested and treated for any STIs too, before having sex, decreases your risk. Do not inject drugs, but if you do, only use sterile equipment, and never share equipment with others.
Our team here at the Ybor Youth Clinic is happy to provide free HIV/STI testing for free for those aged 14-24, call (813) 821-8955 to make your appointment today! Additionally, for more information about HIV and STI prevention visit our website https://www.teenconnecttampabay.org/stds, you can also find clinics near you that offer HIV/STI testing, treatment, and prevention services using our online searchable directory at TeenConnectTampaBay.org!
Miranda Sullivan, MD
PGY-3 USF Internal Medicine & Pediatrics
Ybor Youth Clinic - You can learn more information about making an appointment here!
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