What is PrEP, and how long is the treatment

Pre-exposure prophylaxis or PrEP is a prescription medication designed to prevent HIV infection if taken before coming into contact with HIV.

When taken as prescribed, PrEP medications such as Truvada and Descovy are highly effective. Additionally, they are considered to be extremely safe, and most people tolerate the medicine well.

PrEP prevents HIV infection through sex or needle injection. However, it does not prevent other STIs or pregnancy.

How does PrEP function?

PrEP is like a security guard for your immune system.

While current HIV drugs stop the virus’s life cycle inside immune cells, PrEP medicine works by hanging around in a person’s immune cells to protect against exposure to the virus. Then, if you get exposed to HIV, the virus won’t reproduce or spread through your body and will eventually die.

According to current research, PrEP is 99% effective at preventing the transmission of HIV from sexual intercourse. There is less information on the effectiveness of PrEP when it comes to the injection of drugs, but current research suggests that it’s at least 74% effective against HIV transmission when taken as prescribed.

The PrEP treatment needs seven days of daily use to reach its maximum protection for people who participate in receptive anal sex (bottoming). For injection drug use and receptive vaginal intercourse, PrEP requires 21 days of daily use to reach its maximum protection. Unfortunately, there is currently no data on insertive anal sex (topping) or insertive vaginal sex.

How to access PrEP

You need a prescription from a healthcare provider to get PrEP. Additionally, you’re required to get tested regularly for HIV, STIs, and your kidney health.

Access to PrEP in Canada depends on the province or territory you reside in. For example, in Quebec, PrEP is covered by the Régie de l’assurance maladie du Québec (RAMQ). In Ontario, however, PrEP is free for anyone under 25 through the OHIP+ program, and for those who have federal health insurance (indigenous people with status, members of the armed forces, and refugees), as well as people who are 65 or over, or are on ODSB or Ontario Works. Otherwise, you will need to be on a private drug insurance plan or apply to get PrEP through Trillium. 

PrEP medications

There are two medications that are approved as PrEP by the US FDA. These are Truvada and Descovy. Additionally, there are generic versions of Truvada that can be used for PrEP. Furthermore, both Truvada and Descovy have been used to treat HIV infections; therefore, there’s a lot of real-world data about their effectiveness.

Both of these medicines combine two drugs into a single pill; emtricitabine and tenofovir. Descovy has 200mg of emtricitabine and 25 mg of tenofovir. While Truvada has 200mg of emtricitabine and 300 mg of tenofovir.

Truvada is effective for everyone, whereas Descovy is known to be best for gay and bisexual, cis men, and trans women. Furthermore, there is no clinical data to support the use of Descovy in people who inject drugs or have vaginal sex.

Both of these medications have overall low rates of side effects. However, some people may experience “start-up” symptoms such as diarrhea, vomiting, and nausea. These symptoms typically resolve in the first three months of PrEP use.

Truvada has shown evidence of a small degree of weight loss with use, whereas Descovy has demonstrated a small degree of weight gain. Additionally, Truvada may cause slight decreases in HDL, LDL, and total cholesterol, whereas Descovy may cause small increases in LDL cholesterol and triglycerides.

To determine which medication is best for you, you should speak with your healthcare provider.

How to take PrEP

There are two methods for taking PrEP; PrEP 2-1-1 or Daily PrEP.

PrEP 2-1-1 is also known as event-driven PrEP. Instead of taking the drug once a day for a set amount of time, if you’re at risk for HIV transmission, you take two pills anywhere between two and 24 hours before a sexual encounter and one pill 24 hours and 48 hours later.

Daily PrEP is exactly what it sounds like; you take the drug every day for a set period of time. For instance, for anal sex, you need to take seven lead-in doses. Lead-in refers to the period before sex. For vaginal or front hole sex and blood exposure (like sharing needles), 20 lead-in doses are recommended.

Side effects of PrEP

In general, most people don’t report having any side effects when taking PrEP. When side effects occur, they tend to be mild and usually resolve within the first one to three months.

The most common short-term side effects are nausea, vomiting, diarrhea, and loss of appetite. Furthermore, side effect rates are similar whether you use the daily PrEP or PrEP 2-1-1 method.

In most cases, you can treat mild symptoms with over-the-counter medications. However, if you have a side effect that bothers you or doesn’t go away, you should speak with your healthcare provider.

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