In this video I just wanted to share how to quickly check for any interactions between PrEP and prescription medications you may be taking. While Truvada (Tenofovir & Emtricitabine) are a well tolerated medication there are a few drugs that can interact. In particular, medications that can affect the kidneys are always worth checking with […]
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Hey, guys. It’s Dr. George here. I’ve just been part of a thread on Facebook where we were talking about the storage of Truvada, the drug that’s used for HIV treatment, but also for HIV prevention. I just wanted to share some tips when it comes to the best way to store your medications. Now […]
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Just wanted to say a special thanks to Mu Delta for kindly agreeing to share his experience of PrEP not only from a user perspective but also for someone in Europe. PrEP is now starting to increase in use in Belgium. If you would like to learn more about PrEP be sure to enjoy the […]
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Reported at Avert.org, PrEP has now included in the World Health Organization’s (WHO) essential medicines list. Earlier this month, the World Health Organization (WHO) updated their list of medicines deemed ‘essential’ as part of a well-functioning health system. That is, the drugs that every person should have access to, should they need it, no matter […]
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One of the more common questions for people who are going on to PrEP is, does this mean that I can stop using condoms? We know that condoms have a role in all sexual health, not just HIV prevention. Taking PrEP every day does greatly reduce the risk of HIV infection. Adding condoms into the […]
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PrEP does have some rare side effects that are very important to follow through with. The first one is that in some people, PrEP can reduce the function of the kidney. For this reason it’s very, very important that when you’re starting PrEP, that you have a very careful examination of the patient’s medical history. […]
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What are the contraindications of going onto PrEP? The number contraindication to go onto PrEP is that the person is already infected with HIV. For this reason, it’s very important at the beginning of the screening process that we do a test for HIV. We’re looking for HIV-1 antibodies, HIV-2 antibodies, and if we can […]
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It’s important to have a review of people’s medications before they start PrEP. Any medicines that could affect renal function are worthwhile making sure that everything is okay. Examples include people who are on ACE-inhibitors, people who are on metformin, or who regularly use [inaudible 00:00:20], all of these drugs can affect kidney function so […]
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If you have a patient who there may be a risk that they have been exposed to HIV one month before initiating PrEP, I like to organise a second appointment to confirm HIV status before the person starts taking the medications. My normal flow would be that I organise the full screening tests, and if […]
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Follow-up appointments for PrEP are fairly straightforward and can be done in a systematic way in a 15-minute appointment. The first thing I like to do is have a conversation with the patients about how everything is going. Have they had any issues with the medications? In particular, are they having any side effects, and […]
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The screening tests that I like to organise before starting PrEP include: I like to check kidney function. We need to know that the kidneys are working well and that they have an estimated glomerular filtration rate of more than 60. This is also a good opportunity to review a full sexual health screening. This […]
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If a person misses an occasional tablet of PrEP, it’s not a huge impact on the efficacy of the drug. The most important thing is that we want to reinforce that people take the tablet every day. An occasional missed tablet is not going to greatly reduce the protection against HIV. The protection against HIV […]
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Anybody who at medium to high risk of HIV infection is a good candidate for PrEP. This can include people who are in a serodiscordant relationship, i.e., the person considering going on PrEP is HIV-negative and their partner is HIV-positive. Other people include men who have sex with men, who inconsistently use condoms; people who […]
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Sometimes people are confused with the generic versions of Truvada. The three main generics that I do recommend is Tenofivir-EM, Ricovir-EM, or Adco Emtevir. These three are the main options that are provided under licence from Gilead and these are manufactured in a number of sites across the world. However, to help ensure compliance and […]
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https://www.youtube.com/watch?v=Vg59jFubWOU The general flow for my follow-up appointments is that I have a conversation with my patients about any side effects, any issues that they’ve had with taking the PrEP. I do ask about missed tablets because a good opportunity to help reinforce ways that they can be more compliant with taking their medicines. It’s […]
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What is the legal status of importing PrEP in Australia? It is perfectly legal to import generic Truvada into Australia. However, there’s some things that we can do to help ensure that our patients are compliant with the law. The first thing is that we have to provide the prescription for the patient to be […]
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In some people there have been concerns about bone density and the risk of fracture when taking PrEP. This is actually an extremely rare side effect. What we can say is if you have patients with pre-existing bone density issues or they are at high risk of osteopetrosis, it is worthwhile to consider a bone […]
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How do you guide people on how to take PrEP? Currently the recommendations in Australia are that PrEP is taken every day. What I’d like to talk to my patients about is to find something that they do on a regular basis and tie taking the medicine to that. Say, for example, if they take […]
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If you discover that a person is HIV positive during the screening process of starting PrEP, the most important thing is do not start PrEP. PrEP is not appropriate for this person, this person needs to be on HIV treatment which involves three agents that are active against HIV. Truvada or PrEP only has two […]
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When I talk to patients about how to import the drug, I personally take them to the PrEP Access Now website, http://pan.org.au. I walk them through the process. Key points that I want to remind them about is that they should never import more than 90 tablets at a time. I also want to reinforce […]
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What are the common side effects of PrEP? PrEP is actually quite a robust medication and it doesn’t have a huge amount of side effects. Probably the most common side effect is on initiation it can cause some abdominal side effects. This includes for some people constipation, for some people loosening of the stool, and […]
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Some people can be at risk of sexually transmitted infections as is everybody who is sexually active. Every three months it’s a perfect opportunity to do a full sexual health screening and this includes a throat swab for chlamydia and gonorrhoea, a rectal swab for chlamydia and gonorrhoea, a urine test for chlamydia and gonorrhoea, […]
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If a person is living with hepatitis B, PrEP can lead to an increase in hepatitis B viral load when the medicine is ceased. For this reason, if you have a patient who has been infected with hepatitis B, it’s worthwhile talking to a HIV specialist or PrEP specialist before initiating PrEP.
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After discussion on any particular issues with the tablet, I like to make sure that the person is having any problems in being able to take it every day. This is a really good opportunity to be able to talk about different strategies to improve the ability for a person to take the tablet daily, […]
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In an asymptomatic person, a urine test for chlamydia, gonorrhoea, PCR, is best done. They say to have at least two hours since the last episode of urination. We want to get the first part of urine that comes out of the body. If a person has a pustular discharge, it is worthwhile to also […]
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How does PrEP work? PrEP is a combination of two drugs: Tenofivir and Emtricitabine. The way it works is it stops HIV’s ability to create the second strand of RNA that is later used to enable replication within the T cells. When taken every day, Truvada, the combination of the two drugs, actually stops HIV […]
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PrEP is only effective against HIV. It does not affect any other sexually transmitted infections. For this reason, it’s really important that you reinforce the idea of regular sexual health screening, as well as the use of condoms and their ability to help reduce the transmission of STIs as well.
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Other contraindications to go onto PrEP is kidney disease. If a person has an estimated GFR less than 60, PrEP needs to be initiated very carefully. It’s worthwhile having a conversation with a HIV or PrEP specialist before starting PrEP.
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What is PrEP? PrEP is a medical intervention that helps reduce the risk of HIV infection in people who are at risk of HIV infection. It’s a tablet, and when taken every day, it can reduce the risk of HIV by up to 99%.
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Information for doctors wishing to prescribe PrEP
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I am fascinated at the response, or even that a response was required, by the editor of Attitude Magazine’s article on having a 3 month trial of PrEP. What concerns me is the almost puritanical responses of people that reinforce slut shaming, “sex is bad” messaging infused with blaming of men choosing to control their […]
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PrEP has been recently discussed in The Age newspaper after a recent PrEP user seroconverted to HIV positivein Melbourne Australia. Seroconverstion is when a person becomes infected with HIV, going from HIV seronegative to HIV seropositive. Hundreds of thousands of people use PrEP worldwide, but there have only been two confirmed cases of infection with […]
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Is imported generic Truvada safe? I must admit when I first stated prescribing PrEP I was concerned about whether or not the generic versions of these drugs were safe. What I can now tell you is that the manufacturers of generic Truvada are doing so under licence from Gilead. To be able to do this […]
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“Which generic version do I bring into Australia?” There are a number of different choices of generics, and what I would recommend is making sure that you buy through a website that is well-established and has a good relationship with a number of providers of generic drugs. The one site that I recommend as the […]
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Don’t Take PrEP With Psyllium (Metamucil™) One important thing that I would like to note is the combination of Metamucil™ or psyllium husks and PrEP medication. When you take cilium husks, it’s designed as a way of helping keep bowel movements regular. It’s normally a teaspoon that’s mixed into a glass of water. It creates […]
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Do I need a prescription to import PrEP into Australia? Currently to import PrEP into Australia, you do need a prescription. You need to do is talk with your doctor and they supply you with a script for 90 days worth of PrEP. Most of the companies that supply PrEP from overseas do require you […]
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How much PrEP can I legally import into Australia? Currently, it is legal to import PrEP into Australia. However, it’s important to note you can only bring in 90 days worth of medication in at a time. This works out conveniently because, as part of the PrEP follow-up, it is important to be getting a […]
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Are there any supplements or other medications that I need to avoid when taking prep? It’s important that, when you start prep, that it is prescribed by your doctor and they can look at all of your medications and check for any interaction that could be present. If you are starting a new drug that […]
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What was the biggest “side effect” I personally noted on PrEP? By far the biggest side effect I have had with PrEP has been a monumental shift in my own belief structures. I grew up in the “bad old days” of HIV. Days where there was only one highly toxic treatment available. Days where funerals […]
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One of the more tricky questions that has been posed is, “If somebody is on PrEP and HIV-positive semen is deposited into their rectum, and then a second person was to come along and have anal sex with that person,” i.e., their penis would be running into the semen that was previously left, “could that lead to the transmission of HIV?” This is one of those holes in the Swiss cheese lining up kind of arguments, and the risk is pretty much theoretically zero. It’s a very crazy, bizarre situation that people have created to try and sort of figure this one out.
But let’s put another spin on this. We are all personally responsible for our sexual health. Therefore, everybody is able to control their own status by taking a medication called PrEP. Therefore, everybody should be able to make a decision on their own and not depend on other people. So, for that second person coming along who is having unprotected anal sex as a top, they should be considering being on PrEP.
That’s the real point to this whole argument that I see, is that we all have the opportunity to be able to control our sexual health. Therefore, if you are having anal sex without condoms, whether you’re a top or whether you’re a bottom, you are at risk of infection with HIV. Therefore, you should be considering going on PrEP to protect yourself against HIV. If you are not on PrEP, then you should be considering using condoms for anal sex.
Currently in Australia there are a number of different ways that you can access PrEP. There are firstly, a number of studies happening in Australia. If you’re able to be enrolled in one of these studies, it means that you will be supplied with the drug, either for free or at a very economical rate.
Part of being in the study means that you will need to sign consent forms, as well as be available for regular screening check-ups. Every state in Australia does have a PrEP study at the moment, so it’s important you contact your local AIDS organisation and they will be able to help you learn more about the studies that are available. I’ll put links underneath this video that show where the studies are currently in Australia.
If you’re not eligible for a study, another way to get PrEP is to import it into Australia. This can be legally brought into Australia from companies around the world that are supplying generic Truvada. This can range in pricing, ranked from $37 US a month, up to about $70 US a month and the prices are very dynamic. There are a number of different ways you can access and I will place a link to a great website here in Australia, pan.org.au PrEP Access Now. They have lots of up-to-date information on how you can import PrEP in to Australia.
Finally, the last way you can import PrEP or get PrEP in Australia is to buy it directly. In Australia that would be buying Truvada. It is quite expensive, it ran about $600 a month.
“But isn’t there people who have become HIV positive while taking Prep?” There have been cases around the world where people have become HIV positive while taking PrEP. By far the biggest risk for becoming HIV positive while taking PrEP is not taking the medication. We know that the efficacy of this drug is dropping dramatically when less than four tablets are taken each week. For this reason, we do recommend that people take their tablet every day.
Worldwide, there have been some cases of people who have become infected with HIV whilst reliably taking the medication. Of these cases, two of the cases were people who were infected with an extremely rare strain of HIV that was resistant to both of the drugs in Truvada. This is actually extremely rare, and when you compare that to the tens of thousands of people who have been protected against HIV these are quite freak events.
There is one case where somebody has become infected with HIV and was not infected with a resistant strain and there is ongoing research into this particular case to learn more about what has happened in this particular episode. What we can say is that when taken every day, the efficacy of PrEP is high, around about 99% for people who take the tablet daily. This is significantly higher than what we would expect for other interventions such as immunizations for the flu, mumps, or measles, which can be around about 70-86%. This is a very effective treatment, however we acknowledge that it is not 100%.
However, we want people to go into this with the full information and understanding that when taken reliably, it is extremely effective at preventing HIV infection.
If you are going to import PrEP into Australia, it’s very important that you have a conversation with your doctor, who is familiar with PrEP. They will be able to provide you not only with a prescription for a PrEP but you will also be able to get some information on how to import it. When you are buying from overseas, you will be purchasing generic Truvada. Generic Truvada is exactly the same as regular Truvada. However, it’s made in companies that have been licenced by Gilead, the creator of Truvada. Under this licence, they can produce the generic PrEP that you can import into Australia.
When you’re bringing medications into Australia, there are a few things that are important. One, you do have to have a prescription by your doctor. You then go to one of the many websites where you can buy PrEP online. Pan.org.au is a great website that lists the current places you can buy PrEP online. When you place an order, you will often have to send in a copy of your prescription. That’s easy to do. Take a photo with your phone and you can send that photograph along with your order proving that you have a medical prescription to be able to bring it into Australia. It’s important. Keep that script, because when the drug comes into Australia, customs may ask you why you’re importing it and you can say, “I have a prescription from my doctor and this is how I’ve been able to obtain it.” Do not ask for more than 90 days worth of medications. The legal limit to bring into Australia is 90 days. Anything more than that will be stopped by customs and could be destroyed.
PrEP does have some side effects and it’s important that you let your patients know about these before they start. There is a small group of people who can get an upset tummy when they first start taking the drug. Not everybody gets this, but those who do get it they tend to get either a bit of bloating, a bit of cramping, some people will get diarrhoea, other people will get constipation. Tricks around this is you could either recommend … I recommend acidophilus yoghourt or any of those acidophilus kind of drinks that they can help reset the gut biome and help the patient feel a little bit more comfortable. If it’s particularly bad, you can adjust the timing of the taking of the drug to a time that if they get nausea after taking the tablet, if they take it at night before they go to bed, the nausea will often happen while the person is asleep so that won’t affect them as strongly. If this does occur, it usually only lasts between one to two weeks and then it dissipates away.
One of the other potential side effects is reduction in kidney function. This is not very common at all, however it is an important one. If you’re noticing that the EGFR is starting to drop when somebody is taking PrEP, it’s very important to talk with an infectious diseases specialist about the best pathway it would be before you continue forward with the PrEP. The results will depend on the particular pathway you wish to go. When somebody has a drop in EGFR, sometimes you can just reduce the frequency of the drug. That should be enough to ensure that there’s enough Truvada in the system to protect against HIV without damaging the kidney, however it is important to talk with an infectious diseases specialist if you have patients in this category.
There is a question about reduction in bone density. What we know is that there are a number of factors that lead to reduced bone density. If you have patients who have osteoporosis or are at high risk of osteoporosis, it’s probably worthwhile to do a bone density scan before starting PrEP. At least that way you have a baseline. I always recommend that people have calcium rich foods like yoghourt, cheese, anything like that, and also some regular weight-bearing exercise and access to the sun or vitamin D supplementation. All of these together help reduce the chances of reduced bone density. So it is important to get your patients up and moving, exercising, and that way you can ensure that they are stacking the deck to make sure that their bone density is good and strong.
When you’ve made the decision that PrEP may be a drug for you, it’s important to get in contact with a doctor. Here in Australia, PrEP has to prescribed by a medical doctor. You cannot order it online without a prescription. So, this is an opportunity for you to have a talk with your doctor about your own circumstances and your own particular risks of infection with HIV. Before persons can start taking PrEP, it’s very, very important that we check a couple of parameters.
First things first, we need to be absolutely sure that you are not HIV positive. For this reason, we will do HIV testing before you start. If you have had a potential exposure to HIV close to the time that you want to start taking PrEP, we may need to do HIV testing a little bit more frequently to be 100% sure that you are not HIV positive. If you are HIV positive starting PrEP, it’s not ideal and you need to be on HIV treatment rather than HIV prevention.
Other tests that we routinely do when starting PrEP is that we want to make sure that you are not infected with hepatitis or other sexual transmitted diseases. At the start of every person starting PrEP, I like to do a kidney function test, hepatitis A, B, and C. I also do a full sexual health screening and this includes a swab of the throat for chlamydia and gonorrhoea, a swab of the bum for chlamydia and gonorrhoea, a urine test for chlamydia and gonorrhoea, as well as bloods for HIV, syphilis and as I said we do check for also hepatitis A, B, and C status.
People who are interested in PrEP are number one people you should be talking to about PrEP. However, there are a number of groups of people who could benefit from PrEP. Primarily, HIV is a disease within the gay community of Australia, within men who are having sex with men. In particular, HIV is highest risk for people who are having condomless anal sex, whether they be the top or the inserted partner, or the bottom or the receptive partner. Both of these positions are a risk for development of HIV. So both of these groups of people should be considering whether or not they want to go onto PrEP.
The main groups of people that we are targeting for PrEP are, people in serodiscordant relationships, somebody who’s got an HIV positive partner when that person is HIV negative. Somebody who’s unreliably able to use condoms on a consistent basis, and somebody who has recently had a diagnosis of either rectal gonorrhoea, rectal chlamydia or syphilis. These are all risk factors, putting the person at a higher risk of developing and exposure to eventual infection perhaps, of HIV. This is a group of people that you definitely want to be talking to about PrEP.
Truvada, the drug that is used in PrEP does has some side effect and it’s important to be clear and open about how these can be affected. When you first start taking PrEP, it can upset the tummy a little bit. Not everybody gets this side effect, but some people do. When it does occur, it can be a bit of bloating, a bit of constipation, and some people may get diarrhoea.
What I do recommend is having some acidophilus yoghourt or any of the live culture drinks to help improve the bacteria and healthy biome within the gut. This can help the symptoms a little bit. In most people, if it occurs, it only lasts for between say one to two weeks and then it dissipates.
In some people, PrEP can affect the function of kidneys; this is quite rare. However, in some people in already existing kidney disease, people with diabetes, or people who are on medications that can affect kidney, you may be at risk of a small reduction in kidney function. We monitor kidney function very carefully when people are taking PrEP, not only when you start taking PrEP, but every three months during your treatment. What I do know is that when people go off the drug, kidney function normally returns back to its normal levels.
In my clinical experience, I have only ever taken one person off PrEP because of reduced kidney function. I also have two patients within my clinic who are possessing only one kidney and they’re absolutely fine. So it is important, though, if you have diabetes or any kidney issues, have a very careful and open conversation with your doctor to make sure that there are precautions that can be taken if you are start taking PrEP.
How do people access PrEP within Australia?
There are three pathways currently for accessing PrEP. The first and the most common one is involvement in one of the studies that’s happening in Australia. Queensland, New South Wales, Victoria, South Australia, Western Australia and the Northern Territory are all participants in a variety of different studies that are looking at PrEP. These studies aren’t necessarily looking at is PrEP effective. We already know that PrEP is effective. However, they’re looking at the way that it’s used within our community, so what it does do is that it enables people to get access to the drug much, much easier.
The primary ways, if you’ve got somebody who’s interested in going on PrEP, first, try and see if you can get them on to a study. This makes their life a heck of a lot easier and connects them into an infrastructure to be able to get their regular screening that’s required. If this person is not eligible for a study, then another way to get PrEP in is to import it into Australia and I will create a video that explains exactly how to do this. You can legally import generic PrEP or Truvada into Australia, 90 days’ worth of medication at a time, and I’ll talk about the ways to do that in a subsequent video. Finally, the last way that people can access PrEP here in Australia is to actually buy Truvada directly. However, this is expensive at over $600 a bottle. Not many people will opt for this choice.
If I’m taking prep, does this mean that I won’t be able to be treated with the drugs in the future if I become HIV positive?
When somebody’s taking prep, they’re HIV negative, we’re using it as a prevention tool. For HIV resistance to occur, a person has to already be infected with HIV. Therefore, as long as you’re taking the tablets reliably, the chance of HIV infection is greatly reduced by 99%. As long as you’re HIV negative, resistance cannot occur. If you stop taking prep and become infected with HIV in the future, you will still be able to be treated with the drugs found in Truvada, assuming that the strain of HIV you’ve been infected with can be treated with the drugs within Truvada.
If a person becomes infected with HIV while taking prep, there is a chance that resistance could develop. For this reason, it’s very, very important that you are getting a regular screening when you’re taking prep. Here in Australia the recommendations are that you come in every three months for a full sexual health screening, including HIV. If we notice anything unusual happening with the bloods at this time, we are able to get in, work out what’s going on, and then find a treatment to switch to to ensure that you’re getting the optimal treatment for HIV.
Currently, the studies are working very, very hard to recruit doctors in rural Australia to ensure that all Australians at risk of HIV infection are able to access this medication. All doctors can actually prescribe prep if you are going to be importing it into Australia. It would be great to have more doctors who are recruited and who are educated, and who are trained in how to prescribe prep.
Part of the reason for this project is to help ensure and recruit more doctors with an interest in offering prep to patients, no matter where they live. However, if you are in rural Australia, you can absolutely import prep into your town, no matter where you are. The trick is finding a doctor who is willing to learn how to set up the schedule to ensure that you are getting the best care available for your prep journey.
When taking PrEP, it’s very, very important that you have a regular check-up every three months. This is an opportunity not only to give you your new script for PrEP, but also to check for any potential exposures to HIV, as well as other STI’s.
Routinely, we also check kidney function, so you can expect every three months to come in and you’ll be getting a full screening. This will include a throat swab for Chlamydia and Gonorrhoea, a rectal swab for Chlamydia and Gonorrhoea, urine tests for Chlamydia and Gonorrhoea, and blood tests. We’ll be checking kidney function as well as HIV, Syphilis, Hepatitis C, this is an important regular screening, as it helps ensure that you are taking the medication in a way that’s optimal and safe for you. It’s also a great chance for you to be able to ask any questions or bring up any potential side effects that you are having with taking PrEP.
Am I able to take PrEP if I’m drinking alcohol or taking recreational drugs? We know that the drugs within Truvada are unlikely to interact with alcohol or recreational drugs. What’s important to note is, if you are more likely to have unprotected sex when you are using alcohol or drugs, PrEP is an important drug for you, because it can help insure your safety.
If I need to be fasted for say a blood test or an operation, will missing a dose make me at risk of HIV infection? The occasional missed dose of Truvada is not going to cause major harm. What we can say is say, for a blood test, if you need to be fasted in the morning, it’s okay. You can get the blood test done and then after you’ve had your tests, take your medicines as you normally would. If you are fasted, say, for an operation, it’s perfectly okay to be able to take the medicine after the operation, say, if it’s six hours after you’d normally take it, that’s okay. However, if you do miss the occasional tablet, it’s not that big a deal. You will still be protected against HIV.
It’s when you start taking less than four tablets a week that the protective effect of Truvada drops off rapidly.
There are a number of different studies that look at ways that you can take PrEP. However, here in Australia, our recommendation is that PrEP should be taken every day. When PrEP is taken every day, what we know is that there is enough drug within the system to reduce the risk of HIV infection by up to 99%. It’s very important that you find a regular routine to take the tablet. For some people, I say find something that you do on a reliable basis every day and then attach taking that drug at that time. For example, if every morning you have a coffee, take your drug, put it beside the coffee jar as a reminder to take the medicine every day. Sometimes, using an app on your phone can be helpful as a reminder to take your tablet. It may also be useful to get a small container and place one or two tablets of your PrEP inside that container and throw it into your work bag. That way, if you forget to take a tablet, you’ve got one with you and you can take it straight away.
Does being on PrEP mean that I can give up condoms?
Often, the reason that people are going onto PrEP is because they weren’t actually using condoms to start with. What we have found is that if a person is using PrEP as their protection against HIV, if they don’t use a condom or a condom breaks every now and then, they will still be protected against HIV. We do recommend that people continue to use condoms, because they can help reduce the risk of other sexually-transmitted infections, such as chlamydia, gonorrhoea, syphilis, and even herpes. They don’t absolutely protect against these transmissions; however, they can help reduce them.
The answer is no, PrEP is not just for gay men, it’s for all people who are at potential risk of HIV infection. This includes men who have sex with men, trans men, trans women, as well as female heterosexuals. For women or owners of cervixes, we recommend that people are taking Truvada for at least 21 days before they will have levels that offer the best protection against HIV.
It’s important that you talk to your doctor to make sure that you are getting the correct information when it comes to the dosage of PrEP, and how long you need to be taking it before you are offered full protection against HIV.
The answer is no, you don’t need to take the drug with any particular time of day or any particular food. The most important thing is that you find a way to take the tablet every day. If, ideal, you take it at the same time every day, not necessarily because of urgency or timing, but it’s about setting a routine, setting a regular practise that you have so you will always remember to take your drug every day. And when you take it every day, we know that it reduces the risk of HIV infection by around about 99%.
Does the presence of a sexually-transmitted infection mean that PrEP will no longer be effective? This is shown not to be true. PrEP will work rather or not you have other infections in your body. The mechanism of PrEP is not affected if you have, say, an ongoing infection of syphilis, gonorrhoea, chlamydia, or even a chest infection or a cold. As long as you’re still able to take the medicine on a daily basis, you will be protected against HIV.
If I’m a top, does that mean I don’t need PrEP? What I can tell you is that HIV is still able to be transmitted to people who are tops in anal sex. That is the insertive partner. Men who have foreskins are at significantly higher risk of transmission of HIV, as the insertive partner. Even if you are circumcised, the risk is still quite high for the transmission of HIV. However, it’s not as high as receptive anal sex. Yes, if you are a top, and you aren’t reliably using condoms for anal sex, you are still at risk of HIV. Therefore, PrEP is something that is worth considering.
When HIV infects a cell, it has an ability to take over some of the mechanisms within the cell and start creating copies of itself. When PrEP is taken on a daily basis, this ability is actually halted. It’s the equivalent of putting in a faulty cartridge into the photocopier. So, what it means is the ability for HIV to replicate is halted. What happens then is that the HIV is stuck within the cell, it’s not able to escape, and our healthy immune system is able to come along and kill the cell including the HIV, which is trapped inside.
PrEP protects against HIV, however, it does not protect against other sexually transmitted infections. Chlamydia, Gonorrhoea, Syphilis, Herpes- these can all still be transmitted while you’re on PrEP. What we know is the use of condoms can reduce the chance of transmission of these. So, we do recommend that people consider using condoms at the same time as PrEP.
There have been studies done worldwide that looked at other dosing schedules which include taking two tables of Truvada before you’re thinking about having sexual activity, usually two to 24 hours before activity and then one tablet every 24 hours for two days after the sexual activity. This has shown to have a good effect, however there is still ongoing study in this area and currently in Australia, our recommendation is to take the tablet every day.
The answer is no. PrEP only protects against HIV.
For this reason, when you come in every three months, we do a full sexual health screening. This includes checking for chlamydia and gonorrhoea in the throat, bum, penis or cervix. We also do a blood test where we check for HIV, kidney function, syphilis, and other potential infections, including Hepatitis C
The good thing is that there is a bit of leeway when it comes to taking PrEP. If you are missing a tablet every now and then, it’s not that big of deal. You will still be protected for HIV. However, we do recommend that you take the tablet every day.
If you get to a point where you’re finding difficult to take the tablet or the amount of tablets you are taking drops below, say, four tablets a week, your protection on HIV is greatly reduced.
It is important to take the tablet every day. If you discover during the day that you may have missed a tablet, it’s okay. If it’s been less than 12 hours from the time that you would normally take the tablet, just take one straight away. If it’s been more than 12 hours, it’s okay. You’ll still be protected against HIV. However, do make sure that you take your tablet at the regular time the next day.
If you’ve had a change in situation, where you feel that you are no longer at risk of potential infection with HIV, you are able to stop taking PrEP. However, the recommendations are that you need to take the drug for at least 28 days after your last potential exposure to HIV. This will help ensure that if there have been any particles of HIV in the body that they are able to be fully killed, fully gotten rid of, before you stop taking the tablets.
There was a concern about decreased bone density in people who are taking Truvada. What we have found is that there are a number of factors that can contribute towards the bone density. Most importantly, if you have lower bone density or a strong history in your family of osteoporosis, we can organise a bone density scan before you start taking PrEP.
As part of this though, I’d always recommend to my patients that they have calcium-rich foods, that they get some weight lifting exercises, as well as access to vitamin D or some sunshine to help ensure people are doing everything that they can to get the best bone density possible.
If you are having issues with bone density, we can carefully monitor this and keep a close eye on it. However, reduced bone density is actually quite rare in people on PrEP.
What is Prep? Prep is a tablet that when taken every day can help reduce the chances of HIV infection by up to 99%. It’s a tablet that’s called Truvada which contains two drugs – Emtricitabine as well as Tenofovir and when taken on a regular basis, this can help reduce the chances of HIV infection in people who are at high risk of becoming infected with HIV.
The answer to this question is no. You need to continue taking the PrEP exactly as it was prescribed. One tablet a day is more than enough to protect you against HIV, no matter how much sexual activity you are having. Increasing the dose does not increase the amount of protection that you are offered.
PrEP or Truvada is a combination of two drugs, emtricitabine and tenofovir. Both of these drugs work in a way that blocks the ability for HIV to replicate within the cell. The way that they work is it’s almost like putting in a broken cartridge into a photocopier, and it means that every time that HIV tries to use the body’s mechanism to make a copy of itself, it falters and is not able to progress. This means that HIV is stuck within the cell and the body’s immune system will come along, recognise that something’s happening within that cell and kill it.
No. The good news is that there’s a bit of wiggle room when it comes to PrEP, so if you miss one day, it’s okay, you don’t need to take two tablets the next day.
You just take your tablet as you normally would, and continue forward. It might be worth considering perhaps putting an alarm in your phone, to help remind you take the tablet every day.
I usually recommend that people have a little pill container that they carry in their bag, with one or two extra tablets in there, that way if you forget to take the tablet in the morning, you do have one spare with you, should you require it.
When you start taking PrEP, it takes a little while for the concentrations of the drug to get higher in the blood but also in the tissues of the body. For gay men, it’s around about seven days that you need to be taking the drug before it’s able to offer full protection. In women and trans men, you do need to be taking the drug for up to 21 days before you are offered full protection against HIV.
