What Is PrEP for HIV?
- “Pre” means before. You take the medicine before you think you might come into contact with the virus.
- “Exposure” means contact with HIV.
- “Prophylaxis” means treatment to stop infection in the first place. This is in contrast to treatment for people who either have signs of the virus in their blood (are HIV-positive) or already have symptoms linked to the illness.
How PrEP Medications Work
PrEP stops HIV from taking hold in your body and spreading. If PrEP works as intended, you should not become HIV-positive.
The FDA has approved two pills and one injectable drug for PrEP. FTC/TDF (Truvada) is the main pill that doctors prescribe. It combines two medicines – emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) – to block an enzyme the virus needs to make copies of itself in your body. Truvada is prescribed for those at risk for HIV from either sex or drug use.
The second pill, FTC/TAF (Descovy), isn't prescribed for those assigned female at birth. That's because it's unclear if the drug protects against HIV transmission if you have sex through your vagina.
Both Truvada and Descovy are daily pills
The newest PrEP drug is cabotegravir (Apretude). It's a shot you get from your doctor or another health care provider. Your first two injections are given 1 month apart. After that, you need a shot every 2 months. Apretude is for people who are at risk of HIV through sex and who weigh 77 pounds or more. You must test negative for HIV before each Apretude injection.
How Well Does PrEP Work?
If you take your PrEP pills as directed, they work quite well against future HIV transmission.
You should be able to protect yourself from HIV infection from sexual contact 99% of the time. If you inject drugs and share needles, PrEP isn’t as effective but can protect you in 74% of HIV exposures. The medicine doesn’t work as well if you miss doses. You must take it as directed in order to get the protection.
In clinical trials, Apretude injections offered much stronger protection against HIV infections from sex than Truvada pills.
Who’s Most Likely to Benefit From PrEP?
You’re most likely to benefit from PrEP if you don’t have HIV (are HIV-negative), but your sexual activity or drug use raises your risk of getting it in the future.
Anyone can get HIV. You’re at greater risk for it if you:
- Have more than one sexual partner
- Have anal sex
- Have vaginal or anal sex without using a condom
- Have sex with anyone who has HIV
- Share needles or syringes with someone who has HIV
- Have (or have had recently) another sexually transmitted infection (STI), such as chlamydia, syphilis, gonorrhea, or herpes
So if you’re HIV-negative, you may want to talk to your doctor about PrEP if you have any of the “risk factors” listed above.
PrEP can help protect both you and your baby if you plan to get pregnant from a partner with HIV. It helps block the virus during pregnancy and while breastfeeding. Talk to your doctor about the best way to do this.
Is PrEP a Vaccine?
No. A vaccine causes your body to make special substances called “antibodies” that will fight against a disease-causing germ, like a virus, long after you take the dose. PrEP protects you against HIV only as long as you continue to take it. The effect disappears once you stop taking the medicine.
What Are the Side Effects of PrEP?
Side effects are few and usually go away. Nausea is most common with the pills and happens in about one out of 10 people. You might also have a headache. In most cases, these effects disappear after a few weeks of use.
People who get Apretude shots report side effects more often. They may include:
- Reaction where the shot went in
- Back or other pain
There are no serious or life-threatening side effects.