Answered by:
Stuart D. Federman, PharmD, AAHIVP
Gateway Apothecary
Saint Louis, MO


Pre-exposure prophylaxis (PrEP) helps protect you from contracting HIV. Talk with your physician to see if you fit in with the recommendations for treatment.

The recommendations are as follows:
• Has partner(s) known to be HIV-1 infected, or
• Engages in sexual activity within a high prevalence area or social network and one or more of the following:
• Inconsistent or no condom use
• Diagnosis of sexually transmitted infections
• Exchange of sex for commodities (such as money, shelter, food, or drugs)
• Use of illegal drugs, alcohol dependence
• Incarceration
• Partner(s) of unknown HIV-1 status with any of the factors listed above

Some primary care physicians are not educated about PrEP and as a result are not comfortable in prescribing the medication. Local AIDS service organizations will probably know where to go.

When you get to your appointment with your physician, you will need to do some lab work to make sure that you are able to take the medication. The physician is going to draw an HIV test, a hepatitis B test and a kidney function test.

If you have hepatitis B there are some more specific things that you need to do before using PrEP since one of the medications in the HIV drug Truvada, which is the only currently approved form of PrEP, also treats hepatitis B. If you have not been vaccinated for hepatitis B, your physician will most likely start the vaccination.

Truvada is a pretty well tolerated medication but the most common side effects are diarrhea, nausea and headaches that usually go away within the first couple weeks of therapy. The medication is taken once daily with or without food.

For people without insurance or who are underinsured, Gilead, the maker of Truvada, offers an assistance program. Once on therapy, you will need to be tested for HIV every three months. You will also need to get your kidneys checked in the first three months, then on a semi-regular basis thereafter.

The use of Truvada for PrEP is just the first preventative medication that has been approved. There are drug companies currently researching other forms of prevention, including vaginal rings, as well as long-acting injectable products.

Talk with your physician or pharmacist for more information to help get you through the process of starting PrEP.

Additional writing by Rebakkah Johnson, Pharm. D candidate 2015.