HIV Prevention - PrEP & PEP
New and effective ways of preventing HIV have significantly impacted HIV infection rates. New pre-exposure and post-exposure prevention therapies, coupled with the ability to achieve undetectable viral loads in HIV+ patients, it is feasible that we may completely eradicate HIV by the year 2030.
What is PrEP?
Pre-Exposure Prophylaxis (PrEP) is a prevention strategy that involves taking antiretroviral medications to reduce the risk of HIV infection from sex or injection drug use. It is used as a preventative measure for those who are at an increased risk of acquiring HIV, such as people in relationships with someone living with HIV, people with high exposure to HIV, such as through unprotected sexual intercourse, IV drug use, or for those at heightened risk of coming into contact with infected blood.
What is PEP?
Post-Exposure Prophylaxis (PEP) is a 30-day course of antiretroviral drugs taken within 72 hours of potential exposure to the HIV virus. It is a critical intervention that can stop an individual from becoming infected with the virus, though it does not guarantee immunity.
PEP should be used when there has been a significant exposure to HIV, such as unprotected sexual intercourse or when coming into contact with infected blood.
If you believe you have been exposed to HIV, please call our office to make an emergency appointment. We will see you within 24 hours. We do not guarantee that we have the medication, though we often have available treatment in-office. It is crucial that you contact us as soon as you are made aware of your exposure. We will see you for PEP-related emergencies, even if you do not have insurance.
Approved HIV Prevention Medications
There are currently two pills approved for PrEP in the United States:
- Truvada® – Once daily pill for people at risk for HIV through sex or injection drug use.
- Descovy® – Once daily pill for people at risk for HIV through sexual activity. Descovy® is not for people assigned female at birth who are at risk of HIV infection through vaginal sex.
There is currently one FDA approved PrEP injection medication available in the United States:
- Apretude® was approved in late 2021, and is an extended release injectable suspension that significantly reduces the risk of HIV infection in adults and adolescents who weight at least 77 pounds (35 kg). The injection is given every one month for the first two months, then every other month thereafter.
How Effective is PrEP?
PrEP is extremely effective at reducing the risk of HIV infection when taken as prescribed. According to the San Francisco AIDS Foundation (SFAF) and the Centers for Disease Control and Prevention (CDC), PrEP daily pills are 99% effective at preventing HIV. In clinical trials, Apretude® has had even greater efficacy.
How Long Does PrEP Take to Work?
As with any medication, there are variances in the time for a medication to become fully effective.
- For receptive anal sex (bottoming), PrEP pills reach maximum effectiveness at around 7 days of consistent daily use.
- For receptive vaginal sex and injection drug use, PrEP pills can take about 21 days of daily use to reach maximum protection.
- There is currently no information for PrEP pill effectiveness for insertive anal sex (topping) or insertive vaginal sex
- It is believed that Apretude® takes approximately 7 days to reach its maximum level in your bloodstream. Additional clinical testing is being conducted to confirm this information.
Who Should Be Prescribed PrEP?
According to the CDC, PrEP should be prescribed by anyone who asks for it, including sexually active adults and adolescents who often are not forthcoming about at-risk behavior.
Though PrEP has been around and approved by the FDA for over a decade, there are still doctors and other medical professionals who are unaware of this powerful medication and its effectiveness at preventing HIV infection. If you are seeing a doctor who is unaware or refuses to provide PrEP, it may be time to see a more experienced healthcare provider. Don’t be shy or afraid to talk to your doctor about your health concerns. This PrEP guide to speaking with your doctor will help you prepare.
Paying for PrEP
Many insurance plans cover PrEP. The Affordable Care Act requires that PrEP must be free under most ACA health insurance plans. Additionally, the medication manufacturers offer various copay assistance programs to cover any additional medication costs.