What is HIV PrEP and who should take it?

PrEP stands for pre-exposure prophylaxis. It's medication that helps prevent getting HIV from sex or injection drug use, and it can be an important part of your sexual health and your overall health. 

What is PrEP and how does it work?

PrEP is medication you take before any possible exposure to HIV. When taken as prescribed, it dramatically lowers your chance of getting HIV. Think of it as a proactive layer of protection you can add to your health routine.

There are now several options approved for PrEP:

• Truvada (oral, approved in 2012)
• Descovy (oral, approved in 2019)
• Apretude (injectable, approved in 2021)
• Yeztugo (injectable, a newer long-acting option)

The right choice depends on several factors, including your sex assigned at birth, other medical conditions, other medications you take, personal preferences, cost and insurance coverage and how easily you can follow up with your care team in person or virtually. Your Ochsner care team can help you weigh these factors and find the best fit.

Does PrEP protect against other STIs?

No. PrEP does not protect against other sexually transmitted infections, including HPV, chlamydia, gonorrhea, viral hepatitis, syphilis and herpes. For that reason, condoms are still recommended.

Routine screenings for other STIs and a conversation about vaccinations are also smart steps. Depending on your health history and risk factors, your doctor may recommend vaccines that protect against viral hepatitis, HPV, meningitis and pneumococcal infections.

Who should use PrEP?

PrEP is for anyone who does not have HIV but is concerned about acquiring HIV and wants to be proactive about protecting their health. You don't have to fit a specific profile or gender to benefit. If HIV prevention is on your mind, PrEP is worth discussing with your doctor.

PrEP is approved for adults and adolescents who weigh at least 35 kilograms (about 77 pounds). Laws vary by state on whether an adolescent can access PrEP without parental consent, so ask your care team about the rules where you live.

Can both men and women take PrEP?

Yes. Both men and women can take PrEP. It's an option regardless of your sex assigned at birth or the type of sex you have.

PrEP is also considered safe during pregnancy and breastfeeding, and it can be used alongside contraception. If you're pregnant, planning a pregnancy, breastfeeding or using birth control, talk with your doctor about how PrEP fits into your plan. Protecting your health also helps protect your baby.

Who should not use PrEP?

PrEP may not be the right choice if you:

• Don't know your HIV status and don't want to get tested
• Are living with HIV
• Aren't able to commit to routine testing and medical visits every three to six months
• Have had a recent HIV exposure, in which case post-exposure prophylaxis (PEP) may be more appropriate

How is PrEP taken?

Oral PrEP is taken daily. Taken consistently, it reduces the chance of getting HIV from sex by up to 99%. There's less data on the effectiveness of reducing HIV from injection drug use, but daily oral PrEP is thought to reduce that risk by at least 74%.

There are also two injectable PrEP options. One is a shot into a big muscle every 2 months, after an initial loading dose (lead in dose). The other is two shots under the skin done every 6 months, including an oral loading dose along with the initial shots. Because injectable options are longer-acting, they can be a great fit if remembering a daily pill is a challenge.

There's also a method called "on-demand" or "event-driven" PrEP, where medication is taken around the time of possible exposure. This approach is not currently recommended by the CDC, and the limited evidence available applies only to cisgender gay, bisexual and other men who have sex with men. On-demand PrEP can only be done with Truvada, using what's known as the 2–1-1 regimen. In this regimen, two tablets of Truvada are taken between two and 24 hours prior to sex, one tablet 24 hours later, and one tablet 24 hours after the second dose. If sexual activity continues, one tablet is taken every 24 hours until 48 hours after last day of sexual activity. Different studies have shown effectiveness at 86% or higher. If you're curious whether this option makes sense for you, your doctor can walk you through the details. How is PrEP taken?

When are you considered protected?

For oral PrEP, the time until you are considered protected depends on sexual activity as follows:

• For receptive anal sex, oral PrEP reaches maximum effectiveness after seven days of daily use.
• For receptive vaginal sex and injection drug use, oral PrEP reaches maximum effectiveness after 21 days of daily use.
• For insertive anal sex or insertive vaginal sex, data is limited, so most doctors recommend at least 21 days.

Your care team will let you know when you're fully protected based on your specific medication and situation.

For injectable PrEP, protection generally begins within one to two weeks after the 2-month option. With the 6-month option, protection begins within a few hours of completing the oral loading dose.

Are there side effects with PrEP?

Every medication carries some risk of side effects, but PrEP is generally well tolerated. Some people notice mild, short-lived symptoms such as headaches, abdominal pain, nausea, diarrhea or muscle aches. These usually resolve within a few weeks.

More serious side effects, such as kidney or liver problems, are rare. If they occur, your doctor may adjust your medication or discuss other options with you.

To keep you protected and healthy, routine lab work is part of PrEP. These regular checks confirm the medication is working, watch for side effects and screen for other STIs. In the rare case of a positive HIV test while on PrEP, your care team will connect you with an experienced HIV care team and offer counseling and support.

How much does PrEP cost?

Cost varies by medication and insurance plan. A generic version of Truvada has been available since late 2020, which has expanded access and lowered cost for many people. Many medications also offer copay cards to help with cost, and there are options for people without prescription drug coverage.

At Ochsner, our Specialty Pharmacy team has experience with PrEP and can help you research resources and find an affordable path forward.

How can Ochsner help you start PrEP?

Taking charge of your HIV prevention is a proactive step, and you don't have to figure it out alone. A PrEP-experienced provider at Ochsner can answer your questions, review your options and help you choose the approach that fits your life. Whether you prefer a daily pill or a long-acting injection, we're here to support you every step of the way.

Learn more about HIV PrEP and take the first step at ochsner.org/services/prep.