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Pre-Exposure Prophylaxis (PrEP) for HIV: Meaning, Causes, Symptoms and Prevention

PrEP (Pre-Exposure Prophylaxis) is a medicine that lowers the risk of HIV infection upon exposure. If you are at risk of HIV exposure, incorporating PrEP into your routine can be a vital part of maintaining your sexual health and harm reduction strategies, particularly if you inject drugs.

This medicine is safe to use and works very well if used as prescribed. PrEP is available in two basic forms, i.e. as an oral medication to be consumed daily or as an injection (once a month). 

To determine if PrEP is right for you, approach your healthcare professional and talk about your sexual history, behaviour and drug use practices. They will recommend doses according to your ability to take PrEP. 

Key Facts About PrEP

Following are some of the most important facts and information you must keep in mind regarding PrEP:

• PrEP is a safe-to-consume daily pill that reduces the risk of HIV infection. It belongs to a class of antiviral drugs called nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs).

• Before starting PrEP, or at least once every 2 to 3 months while you are taking the medication, you should undergo an HIV test to ensure you are HIV-negative.

• PrEP is specifically designed for adults and adolescents without HIV but at risk of exposure to HIV through sexual contact or injection drug use.

• While PrEP lowers the chances of getting infected with HIV, it does not prevent pregnancy or other sexually transmitted infections (STIs). Condoms play an essential role in this regard.

• In late 2019, PrEP was introduced as a public health initiative in the Latin America and the Caribbean (LAC) countries. Additionally, 12 other countries are also planning to implement PrEP as a part of their HIV prevention strategies, supported by increased funding.

• By 2020, the goal was to have 200,000 people using PrEP in the LAC countries, highlighting the commitment to expanding access to HIV prevention in the region.

Side Effects of PrEP

Pre-exposure prophylaxis (PrEP) is a widely used medication for reducing the risk of HIV infection. PrEP medicine is usually well tolerated but, like any medication, it can cause side effects in some individuals. Usually, most of these side effects are mild and may diminish after the first few weeks. 

Below is an overview of common and serious side effects: 

• Common Side Effects

The following side effects may affect more than 1 in 100 people taking PrEP. These typically resolve over time and are often temporary:

1. Bloating and indigestion

2. Nausea or vomiting

3. Headache

4. Diarrhea

5. Insomnia

6. Dizziness or feeling weak

• Serious Side Effects

Serious side effects from PrEP are rare, but they can occur. Some of the more significant concerns include:

• Kidney Function: PrEP at times affects the functioning of your kidneys. Doctors typically prescribe conducting kidney tests before and after the treatment. People aged 50 or older, or those with pre-existing kidney conditions, may be at higher risk for kidney-related side effects.

• Bone Health: Although rare, this medication also affects your bone health, especially if you have bone mass density loss (BMD). 

It is crucial to note that the benefits of taking PrEP outweigh the risks of potential side effects, especially when it is used as part of an HIV prevention strategy. 

Causes of HIV

PrEP is a preventive medication aimed at individuals with a high risk of getting HIV infected. The main underlying causes of HIV include:

• Unprotected Sex: Carrying out unprotected sex with multiple partners is the main cause of HIV.

• High HIV Prevalence: Areas where a large number of HIV-positive individuals reside raise the risk of exposure and contracting HIV. 

• Sex Work: People involved in sex work are more prone to HIV exposure and face difficulty in using condoms.

• Stigma and Discrimination: Stigma and discrimination surrounding HIV often prevent people from seeking protection or discussing their sexual health openly.

• Healthcare Disparities: Limited access to preventive healthcare raises the chances of higher HIV infection rates among marginalised communities. 

Types of PrEP

The different types of PrEP are classified as follows:

• Truvada: This PrEP pill is a daily oral pill consisting of two medications that enable blocking of enzymes, thereby preventing the virus from spreading to other tissues. This particular type of PrEP is suitable for everyone. 

• Apretude: Apretude is an injectable form of PrEP. Initially, two injections are given within one month to help establish protection. After the initial doses, Apretude is administered every two months as a maintenance injection. 

• Descovy: This is also a pill to be consumed daily, and it prevents the virus from reproducing. Descovy comprises a different set of medications. However, Descovy is currently only approved by the World Health Organisation (WHO) for use in cisgender men and transgender women.

Risk Factors of PrEP

Several studies have suggested that the majority of individuals taking pre-exposure prophylaxis (PrEP) face potential risks related to renal and bone health. Around 62% of the population taking PrEP are at risk of kidney issues, while 68% experience bone-related concerns. When excluding age factors, approximately 46% of individuals have renal risk factors, and 56% have bone-related risk factors.

The table below displays the risk factors according to age, concomitant medication, comorbidity, and other clinically related measures. These risk factors are most commonly observed in individuals prescribed oral PrEP:

Preliminary Evaluation Before Starting PrEP

Before getting started with PrEP medications, it is essential to undergo a thorough medical evaluation of HIV. The healthcare providers assess the risk of an individual getting affected by HIV by considering factors such as: 

• Injectable drug use

• Sexual behaviours

• HIV status of their partner. 

The key tests conducted during this assessment include:

• HIV screening to confirm the status of HIV

• Kidney function tests

• Tests for sexually transmitted infections (STIs)

In addition to these initial tests, follow-up visits are also recommended to closely monitor side effects and track kidney functioning. These steps ensure the safety of PrEP and its effectiveness, helping individuals start their prevention journey with confidence.

Prevention of HIV

PrEP medication itself is a preventive medication of HIV. It is intended to be used before exposure to HIV. PrEP works well if taken as prescribed and when it is combined with other preventive measures. By incorporating multiple prevention strategies, the likelihood of contracting HIV is significantly reduced. Let us look into several prevention options that work alongside PrEP:

• If you inject drugs, using clean needles and practicing safer injection techniques can reduce the risk of HIV transmission.

• Consistently using condoms during sexual activity is one of the most effective ways to prevent both HIV and other sexually transmitted infections (STIs).

• For maximum effectiveness, PrEP should be taken daily as prescribed.

• Regular testing for HIV and other STIs is essential for everyone, especially for individuals using PrEP.

• Discussing your sexual history, drug use, and prevention options with your doctor ensures that you receive personalized advice and the best possible care.

Specialists to Visit for Treating HIV

To manage PrEP and reduce the chances of getting infected with HIV, individuals should consult with respective healthcare providers specialising in HIV care and sexual health. Here are the specialists you should visit to treat HIV:

• Primary Care Physicians: During the initial phase, PCPs carry out several screenings and tests, assess your overall health, and monitor your progress while on PrEP.

• Infectious Disease Specialist: This category of specialists usually has in-depth knowledge about HIV prevention and offers advice to individuals with a high risk of HIV infection because of high exposure. 

• HIV Prevention Clinics: These clinics are primarily focused on the prevention of HIV transmission and provide consistent care and support relating to PrEP treatment to individuals. 

• Sexual Health Clinic: Sexual health clinics are another great option for accessing PrEP. These clinics offer comprehensive services, including easy access to PrEP prescriptions, regular monitoring, and testing for kidney function and sexually transmitted infections (STIs).

Treatment Options of PrEP

You can take PrEP medication as a whole tablet daily, either orally or in injected form. The following treatment options help to prevent HIV among adults and adolescents with weight of at least 77lb:

• PrEP with F/TDF (Emtricitabine/Tenofovir Disoproxil Fumarate) is recommended to take as an oral medication daily to prevent HIV disease among people who engage in high-risk sexual behaviors or inject drugs.

• PrEP with F/TAF (Tenofovir Alafenamide) is recommended to be taken orally to reduce the chances of HIV through sexual transmission. This however excludes individuals who are prone to get affected with HIV through vaginal sex. 

• PrEP with CAB (Cabotegravir) in injectable form prevents sexual transmission of HIV among all categories of people. This form of PrEP is administered as an intramuscular injection every two months.

Home Care and Lifestyle Changes When Consuming PrEP

You can lead a normal lifestyle while infected with HIV. Consult your healthcare professional and take the necessary steps to remain healthy. Here are some lifestyle changes you should bring about:

• Healthy Eating

A balanced diet plays a crucial role in managing medication side effects, maintaining a stable weight, and supporting your immune system. Make sure to include nutrient-rich foods in your diet that include lean meat, whole grains, fruits and vegetables, fatty fish, nuts and seeds, beans and lentils. 

• Stay Active

Involve yourself in regular physical activities to boost your mood and reduce medicinal side effects. Exercise helps support your immune system, promotes better sleep, and can reduce symptoms of depression.

• Get Enough Sleep

The majority of HIV-affected patients face trouble sleeping. With the right treatment, you can get a good rest at night. Follow sleep hygiene practices, such as maintaining a regular sleep schedule, creating a calm and quiet sleep environment and considering cognitive behavioral therapy for insomnia (CBT-I) if needed.

• Quit Smoking

As and when you are affected with HIV, make sure to quit smoking. Cigarette smoking is not just bad for your health, but it makes the treatment process even more difficult. It also raises other health problems relating to bacterial pneumonia, lung cancer, heart disease, high blood pressure, and others. 

Comorbidities of HIV

The following are the most important comorbidities of HIV:

• Cardiovascular disease

• Diabetes

• Hypertension

• Osteoporosis

• Chronic kidney disease

• Hyperlipidemia

• Obesity 

Alternative Therapies of PrEP

PrEP is the primary prevention against HIV, but there are other alternative therapies as well. These include:

• Use of Condoms: The use of condoms is a must, as it is a great barrier towards the prevention of HIV and other STIs.

• Vaginal Rings: Vaginal rings and topical gels with antiretroviral properties are options designed for women at risk of HIV.

• Exchange of Needle: For individuals who inject drugs, using clean needles is critical in reducing the risk of HIV transmission.

These alternative methods, when used alone or in combination with PrEP, can be highly effective in reducing the risk of HIV transmission.

Frequently Asked Questions

1. What is the meaning of PrEP?

Pre-exposure prophylaxis (PrEP) is an HIV medication individuals consume to lower their chances of getting infected by HIV. The World Health Organization (WHO) currently recommends daily PrEP for both men and women who are at high risk of acquiring HIV.

2. Who is restricted from using PrEP?

Individuals who are already HIV-positive should not take PrEP and should instead begin antiretroviral therapy (ART) to manage their HIV. Additionally, people with kidney disorders should consult their healthcare provider before using PrEP, as it can impact kidney function, particularly with long-term use.

3. Where is PrEP available?

PrEP is becoming more widely available, but it may not be offered in all clinics. Since it is a new treatment, you may also ask your local clinic to assist you in finding PrEP. 

4. Is the use of condoms necessary while taking PrEP?

The use of condoms is not necessary while taking PrEP. However, condoms provide you additional protection against HIV and also safeguard you from other sexually transmitted diseases and unplanned pregnancies. 

5. Will PrEP affect my contraception?

No, PrEP does not interfere with any form of contraception, including emergency contraception or the combined pill. 

6. Are there chances of losing or gaining weight while taking PrEP?

While taking PrEP, you might experience a slight loss in weight or sometimes a weight gain. Make sure to have proper meals without increasing the portion sizes. Doing exercises regularly will also help in maintaining a stable weight over the period. 

7. What might happen if I stop taking PrEP?

If you stop taking PrEP, you will no longer be protected against HIV. If you are still at risk of HIV exposure, it is important to either restart PrEP or consider alternative prevention strategies. Always consult with your healthcare provider before stopping or changing your PrEP regimen.

8. Are there any long-term side effects of PrEP?

Most people tolerate PrEP well, but long-term use can sometimes affect kidney function, which is why regular kidney tests are required before and during treatment. Additionally, bone mineral density (BMD) loss may occur, although this is rare. If you have concerns, discuss monitoring options with your healthcare provider.

9. Is it necessary to avoid driving or riding a bike while consuming PrEP?

Within the first few weeks of consuming PrEP, you might feel dizzy. Do not drive a car or ride a bike during the few initial days. 

Shop for trusted medications, including PrEP and other health essentials, from the comfort of your home. Fast, reliable delivery and expert customer support. Order now and take control of your health today!

Disclaimer: This information is for educational purposes only. Make sure to consult a healthcare professional before starting, stopping, or altering any HIV preventive medications. 

References

https://www.nhs.uk/medicines/pre-exposure-prophylaxis-prep/side-effects-of-pre-exposure-prophylaxis-prep/

https://www.paho.org/en/topics/pre-exposure-prophylaxis-prep

https://www.nyc.gov/assets/doh/downloads/pdf/ah/prep-user-guide.pdf

https://www.cdc.gov/stophivtogether/hiv-prevention/prep.html#:~:text=PrEP%20can%20be%20pills%20or,people%20at%20risk%20through%20sex.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9922808/

https://www.aidsmap.com/about-hiv/prep-failures-breakthrough-infections

https://www.cdc.gov/hivnexus/hcp/prep/index.html

https://pmc.ncbi.nlm.nih.gov/articles/PMC6551550/

https://www.ajmc.com/view/comorbidities-need-to-be-considered-when-prescribing-art-to-optimze-treatment-outcomes

https://www.healio.com/news/infectious-disease/20210217/longacting-injectable-prep-an-exciting-alternative