Truvada is not a morning-after pill as some believe. 72 hours after sexual exposure, they can prevent infection from taking place. It’s something he didn’t think about because he wasn’t aware of it. Researchers have written about the lack of awareness among gay men of the availability of both PEP and PrEP. When there is awareness, it sometimes goes along with misunderstanding or downright misinformation. Truvada is not, for example, a morning-after pill as some believe.
If Truvada is approved for use in HIVnegative individuals, the lack of awareness around its prevention power should change drastically, with education becoming possible by its manufacturer, clinics, and community organizations.
TO BE YOUNG “We see PrEP for youth not as a lifelong medication but as a stopgap measure,” said psychologist Sybil Hosek, PhD, of
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You need to test HIV-negative before going on PrEP (pre-exposure prophylaxis or prevention). This may require multiple testing (for example, testing HIV-negative three months in a row). You must also be tested for hepatitis B before getting Truvada. Your kidney function and serum phosphorus levels (for evidence of bone weakness) should be measured. It takes about three doses (three days) for Truvada to reach adequate levels in your body for protection against HIV. Adherence, or taking PrEP correctly and daily, is required. PrEP must be monitored with continued testing for HIV and other sexually transmitted infections and review of any side effects that may occur. Monitoring may be required every three or four months. Side effect monitoring includes laboratory tests (blood draws) for potential kidney toxicity. It’s widely believed that PrEP should include the use of condoms and behavioral modification (finding ways to lessen the risk of infection). It is possible that not using condoms along with PrEP may allow for the
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risk of infection, possibly negating the effects of PrEP altogether. Other serious infections can occur without a condom and are epidemic in the gay community: hepatitis C, syphilis, and gonorrhea. (Remember that gonorrhea is also spread through oral sex.) People who become HIV-positive while on Truvada PrEP risk the development of drug resistance. In studies, the only risk of drug resistance seen was in individuals who were already positive at the time of starting PrEP but didn’t know it or people who were infected with an already drug-resistant strain of HIV. Health care providers might consider supplementing vitamin D and calcium in PrEP patients. Some patients may also benefit from DEXA bone scans before and during treatment. Research continues to investigate the best uses of PrEP, such as the possibility of less than daily usage and the use of other medications besides Truvada. Other biological prevention methods such as microbicides are also being studied.
READ THE CDC’S INTERIM GUIDELINES:
www.cdc.gov/mmwr/preview/ mmwrhtml/mm6003a1.htm?s_ cid=mm6003a1_w.
Stroger Hospital of Cook County, the Chicago site for the Adolescent Trials Network (ATN) for HIV/AIDS Interventions. “We know that adolescence is a risky time,” said Hosek. “There’s a lot of impulsivity and a lot of behavior changes—hormonal, psychological, and emotional—that put people in vulnerable positions when it comes to HIV. And so we feel that PrEP may be a great option during that maturation period.” The ATN points to CDC statistics showing that among adolescents and young adults (ages 13 to 25), the estimated percentage of HIV infections resulting from male-to-male contact increased from 57% in 2005 to 68% in 2008, while infections resulting from heterosexual contact or injection drug use decreased. For black youth, however, the increase was 73% in that time period. ATN’s Project PrEPare has two studies looking at PrEP effectiveness now that its initial research has shown that youth would accept and use PrEP (feasibility). These two studies are scheduled to enroll 300 youth at the network’s 14 sites across the country, including Chicago. Visit www. projectpare.net. Like other PrEP research, Project PrEPare provides condoms and counseling along with medication. As to the argument that money should be used for treatment of actual HIV infection rather than prevention, Hosek said they’re both part of the same package, with PrEP expected to increase HIV testing levels and awareness of previously unknown infection with the need for access to treatment. Moreover, she said it would help providers talk to their patients about getting HIV-positive partners into care and treatment. Like many advocates, she also points to the fact that Truvada PrEP—especially for short-term use—costs less than a lifetime of HIV therapy. “I think it would help people to remember their own youth,” said Hosek. “It’s a time of exploration. It’s a time of emotional energy and risk taking, of cognitive development. Their brains are maturing. Pleasure often takes precedence over planning. P OS I T I V E LYAWAR E .CO M