Clinical overview: Different options for HIV PrEP help prevent the spread of the disease

Pre-exposure prophylaxis (PrEP) has been shown to be an effective way to prevent the spread and control of infectious diseases. This is especially true among people who do not have HIV but are at high risk of contracting HIV, which may include those who have been exposed to the virus through sexual contact or injection drugs.

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The U.S. Centers for Disease Control and Prevention (CDC) recommends considering PrEP for people who have had anal or vaginal intercourse in the past 6 months, have not used protection during sex, and/or have been diagnosed with a sexually transmitted disorder in the past 6 months.¹

There are 2 main types of HIV prophylaxis. Protection versus prevention is the best option to consider; however, the 2 types of drug therapies that can help with prophylaxis include PrEP and non-occupational post-exposure prophylaxis (nPEP).

PrEP is for people at high risk of exposure to HIV infection, who should also have tested negative for HIV, hepatitis B and hepatitis C, before receiving therapy. On the other hand, nPEP, is used for people who have been exposed to HIV infection within the past 72 hours and need an emergency protection treatment option. This type of prophylaxis is not intended for regular use by patients and for those with regular exposure to HIV.⁴

Two current drugs approved by the FDA for use as PrEP include Truvada and Descovy. Each may be a better option for various patients based on their overall health and condition.

Truvada can be used for people at risk of contracting the HIV virus through sex or injection drug use, while Descovy can be used for people at risk of exposure to the virus through sexual activity.² If these people are exposed to HIV, using PrEP will help stop the virus from spreading in the body and cause full-blown illness. For most patients, PrEP should be used every day to help block the virus.¹

Truvada is a combination of emtricitabine and tenofovir disoproxil fumarate, indicated for patients weighing at least 35 kg. The recommended dosage for HIV-1 uninfected adults and adolescents is 1 Truvada tablet containing 200 mg emtricitabine and 300 mg tenofovir, once daily. This drug can be taken with or without food. It is not recommended for patients with CrCl below 60 mL/min.⁵

Descovy, a combination of emtricitabine and tenofovir, is indicated for patients weighing at least 35 kg to reduce the risk of HIV infection. The direction for this drug includes taking 1 tablet once a day, with or without food. This drug is also not recommended for patients with CrCl below 30ml/min.⁶

Apretude is another PrEP option for patients who are at risk of exposure through sexual activity and who weigh at least 77 pounds (35 kg). Apretude, an integrase strand transfer inhibitor, is recommended as a single 600 mg (3 mL) injection given 1 month apart for 2 consecutive months on the last day of oral induction, if used within 3 days and continued with the injection every 2 months thereafter.⁷

PrEP can help prevent the spread of the virus, especially when taken effectively every day. According to newly available data, routine PrEP use can reduce the risk of spreading HIV through sex by 99%, and by 74% from injection drug use. Other additional protective measures against the spread of HIV will also help against the spread of HIV.²

While considered a safe treatment option, PrEP can cause adverse effects (AEs) such as diarrhea, nausea, headache, fatigue, and stomach pain, especially in patients taking the drug for the first time. These adverse events, if tolerated, disappear over time. It must be said that not everyone experiences these adverse events and not everyone can experience the same ones.²

An important question to ask whenever a patient is prescribed PrEP is how long it will take for it to work. When used daily, PrEP tablets can achieve maximum HIV protection in about 7 days. When it comes to vaginal sex, as well as for drug injections, PrEP pills achieve maximum protection at around 21 days.²

According to recent data, an estimated 1.2 million adults are at a sufficiently high risk of HIV to justify the use and treatment of PrEP; however, only about 70,000 people actively sought therapy from their providers.

In 2020, approximately 34,800 new HIV infections were reported in the United States, including approximately 24,500 (70%) among gay, bisexual, and other men who have sex with men, approximately 7,800 (22%) among people who reported contact heterosexual and approximately 2500 (7%) were injecting drug users.⁸ This highlights the need for education about PrEP, prophylactic strategies for HIV prevention, and timely inquiries from healthcare professionals when it comes to HIV exposure risks.³

References

1. Pre-exposure prophylaxis (PrEP) National Institute of Health. Available at: https://hivinfo.nih.gov/understanding-hiv/fact-sheets/pre-exposure-prophylaxis-prep. Accessed June 1, 2023.
2. Speaking of preparation (2022) Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/hiv/basics/prep/about-prep.html. Accessed June 1, 2023.
3. Beymer MR, Holloway IW, Pulsipher C, Landovitz RJ. Current and future PrEP medications and modalities: on demand, injectable and topical. Curr HIV/AIDS Rep. 2019 Aug;16(4):349-358. doi: 10.1007/s11904-019-00450-9. PMID: 31222499; PMC ID: PMC6719717. Accessed June 1, 2023.
4. cvs extension Tiny clinic. Available at: https://www.cvs.com/minuteclinic/services/hiv-pre-or-post-exposure-treatment. Accessed June 1, 2023.
5. What is Truvada? TRUVADA (elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate). Available at: https://www.truvada.com. Accessed June 1, 2023
6. Descovy prescribing information. Label (fda.gov). Accessed June 1, 2023.
7. Prescribing information for Apretude (cabotegravir). Label (fda.gov). Accessed June 1, 2023
8. HIV incidence (2022) Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/hiv/statistics/overview/in-us/incidence.html. Accessed June 1, 2023.