Gateway Apothecary
4473 Forest Park Avenue St. Louis, MO 63108 (p) 314-381-1818 (f) 314-667-3202
Ripped from the headlines, the WHO (World Health Organization) and the governor of New York say that you should take PrEP (pre-exposure prophylaxis)…Should you?
The short answer, maybe. Truvada, was approved for the treatment of HIV in 2004 which contains a combination of tenofovir (Viread) and emtricitabine (Emtriva). Truvada is a backbone of most of our current HIV regimens. Most patients who have been diagnosed with HIV have used this medication at times either in a single tablet regimen or in combination with other antiretrovirals. Truvada was approved in 2012 by the FDA for the use of PrEP (pre-exposure prophylaxis), to prevent the spread of the HIV virus before becoming in contact with the contaminated fluids. So should you take Truvada?
All medication has the possibility of side effects and Truvada is no exception. Most patients experience minimal side effects that usually go away within a week or two of therapy, but there are certain patient populations who are unable to take the medication at all. Patients who are allergic to any of the components of Truvada should not take the medication as well as people who have kidney damage or the kidney doesn’t work as well. With my experience Truvada’s most common side effects are stomach upset, diarrhea, dizziness, insomnia and nausea and vomiting. Many people do not have any side effects at all. So does the medication work?
Through clinical studies we have found that there are numerous ways to prevent the spread of the HIV virus. The first and most effective way to prevent the spread of the HIV virus is to treat patients who are currently infected with HIV. If we are able to minimize the circulating virus in an infected patient to undetectable that patient almost has a zero percent chance of spreading the virus. Another effective way to help prevent the spread of the HIV virus is a more universal use of condoms to help stem the spread of the virus. The receptive anal partner has the highest risk of contracting the virus and condoms help put a barrier there to prevent the transmission of the virus. Truvada has been shown to be effective in preventing most of the spread of the HIV virus. There have been numerous clinical studies that have proven that Truvada works to prevent infection when taken every day. Most failures occurred in the studies when the non-infected patient had very little or no medication in their body when they became infected with the HIV virus. So why doesn’t everyone just take the medication?
Well the first problem is the cost. Truvada costs about $1250 per month. Some detractors state that if we are unable to provide care to our current patients who are infected with the HIV virus why would we want to use HIV medications in non-infected individuals. Other detractors say that this will lead to individuals taking Truvada to become more careless and have riskier behavior, like not using condoms, or that the use of an HIV medication will lead to resistance if the patient would become infected with HIV. The clinical studies have shown that the use of PrEP did not show an increase in risky behavior or resistance to the medication. So are you ready to take the medication?
The maker of Truvada, Gilead, has created a website, http://www.truvadapreprems.com/ that shares information for both the patient and the doctor. Patients who want this extra level of protection should talk to their primary care physician or asked to be referred to a specialist who has had experience with the use of Truvada to see if they qualify to use the medication. This isn’t a medication that the physician will just say here is the prescription, go get it filled at your local pharmacy. The FDA has put recommendations together to help providers know what labs that they need to draw and how often the patient should be seen and the regularity of HIV tests.
Remember that this medication needs time to get into the body and be at levels high enough to prevent the infection of the HIV virus. It is recommended that patients take the medication regularly for about a month before they become exposed to the virus. This is not a medication that patients can take on a Friday before going out to a party on the weekend, it needs to be taken consistently on a regular basis. Patients should always use condoms in combination to other preventative methods. If possible know the status of your partner before engaging in intercourse. If you have questions about PrEP please feel free to reach out to me or your medical provider.
Stuart
Stuart Federman Pharm D., AAHIVP
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