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    How to Use Pills to Prevent HIV

    CDC: HIV Prevention Pills Only for Men Having Sex With Men
    WebMD Health News
    Reviewed by Laura J. Martin, MD

    Jan. 27, 2011 -- The CDC has issued early recommendations for the use of AIDS drugs to prevent HIV infection of men who have high-risk sex with men.

    The preliminary guidelines follow last November's groundbreaking report that daily use of the AIDS drug Truvada lowers men's risk of HIV infection. This strategy, called pre-exposure prophylaxis or PrEP, can cut HIV risk by as much as 92% in men who take the pill every day.

    But there's a catch. Several catches. For example:

    • Truvada has to be taken every day, not just prior to sex.
    • Truvada, like all HIV drugs, has side effects.
    • Drug-resistant virus develops in men who begin PrEP when already infected with HIV.
    • PrEP does not prevent other dangerous sexually transmitted diseases.
    • Truvada is expensive. Since PrEP is not an FDA-approved use of the drug, insurance may not cover the cost.

    U.S. public health agencies are developing PrEP guidelines. But since the news is out -- and men already are asking their doctors whether PrEP is right for them -- the CDC today issued preliminary guidelines.

    Since PrEP was tested only in men (and male-to-female transgendered women), PrEP should be given only to biological males. Men eligible for PrEP should be at high risk of HIV infection -- that is, they should frequently change sexual partners or have concurrent partners in a region with high HIV prevalence.

    Preliminary PrEP Guidelines

    Here's the CDC's basic advice:

    • PrEP should be offered only to HIV-negative men at high risk of HIV infection.
    • PrEP should be just one part of a comprehensive prevention plan.
    • PrEP must include regular HIV testing.
    • Providers offering PrEP must regularly monitor patient adherence, drug side effects, and HIV risk behaviors.
    • The only PrEP drug regimen tested is once-daily Truvada; other anti-HIV drugs should not be substituted.

    Before starting PrEP:

    When starting PrEP:

    • Take one Truvada tablet every day.
    • Providers should prescribe no more than a 90-day supply, renewable only when HIV testing is negative.
    • Providers should offer counseling on reducing HIV risk behavior and on Truvada adherence.
    • Providers should offer condoms.

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