How Effective is PrEP for Preventing HIV Infection?

🕓 Reading time: 4 minutes

Patients regularly ask me, “How effective is PrEP for preventing HIV.”

The answer is simple: Pre-exposure prophylaxis (PrEP) does an excellent job of protecting you from infection.

In fact, the oral medication is up to 99% effective when taken as prescribed.

ON THIS PAGE

• What is PrEP?
• PrEP vs PEP
• How PrEP works
• Side effects?
• Other HIV prevention methods
• Getting started with PrEP
• About Dr Zack Bukhari

HIV-negative people who are at risk of HIV exposure are the primary users of PrEP.

Those in high-risk groups include men who have sex with men, transgender women, and injecting drug users.

PrEP is also available to anyone who feels at risk of acquiring HIV.

What is PrEP?

PrEP is a combination of two medications, tenofovir plus emtricitabine that comes in a single, once-a-day tablet.

The most commonly dispensed brand of this medication combination is Truvada.

However, the Pharmaceutical Benefits Scheme (PBS) no longer funds Truvada brand pills but funds bio-identical generic brands. These alternates are just as effective as Truvada.

People in other parts of the world use a similar combination tablet for PrEP called Descovy. Descovy contains a different form of tenofovir and isn’t currently available for use as PrEP in Australia.

Long-acting options?

Health authorities are considering placing an injectable formulation on the PBS containing the drug cabotegravir (marketed as Apretude) as a readily accessible, longer-acting PrEP.

Doctors currently use cabotegravir to treat HIV patients under the brand name Cabenuva.

Apretude will offer Australians two months’ protection from HIV per injection, following an initiation phase using tablets to ensure no adverse reactions arise from the medication.

Apretude is currently undergoing the regulatory processes for approval for use in Australia as PrEP.

Still, it will eventually offer another means of protection for those for whom tablets aren’t the best option.

PrEP vs PEP

PrEP shouldn’t be confused with post-exposure prophylaxis (PEP). As the name suggests, HIV-negative people typically take PEP after being exposed to the virus.

The aim here is to reduce the chance of HIV taking hold.

Have a look at endinghiv.org.au for more information on PEP.

How Does PrEP Work?

PrEP blocks an enzyme called HIV-1 reverse transcriptase (HIV-1 RT). This enzyme is responsible for replicating the most common form of HIV as it grows unabated inside the body.

There needs to be enough PrEP in your system to effectively block HIV-1 RT, which is why you need to take the medication as directed consistently.

You can take PrEP daily, on-demand, or periodically.

Daily PrEP is precisely that – a pill you take around the same time each day for as long as you’re sexually active and need protection.

Taking PrEP daily is considered the most effective method. If casual or spontaneous sex is your thing, then daily PrEP will provide you with protection 24/7.

On-demand PrEP suits those who can plan for sex ahead of time, don’t want to take a pill every day, or have other health conditions that the medication might impact.

With this method, you take two pills 2-24 hours before and after you have sex, followed by two more pills over the next 48 hours.

It’s best to talk with your GP about the pros and cons of this option.

Periodic PrEP is when you take a pill a day over a period when you expect your sexual activity to increase. Such periods may include during festival season or when a special friend is in town.

Periodic PrEP is a popular method for people worried about side effects. It’s also a good option for which to begin taking the medication.

Again, please speak with your GP about dosages and timings that relate to your circumstances.

What Are the Side Effects of PrEP?

As with most medications, some side effects come with taking PrEP – though doctors deem these relatively low-risk.

The vast majority of people don’t experience any problems whatsoever. However, some short-term effects may include:

• An upset stomach
• Diarrhoea
• Weight loss
• Mild headaches
• A loss of appetite

In rare cases, PrEP can decrease kidney function in those with pre-existing medical conditions if taken over a long period.

To be safe, most GPs recommend PrEP users get regular kidney tests.

Taking a different perspective, there can also be positive side effects of PrEP, namely improved mental health. For some people, the fear of acquiring HIV interferes with their ability to relax and enjoy sex.

PrEP can be an extra layer of protection in addition to condoms, so people know they’re as safe as possible.

An excellent article on this topic is “Sex Without Fear” by journalist and novelist Tim Murphy.

What are Some Other Ways to Safeguard Against HIV Infection?

Whether you’re taking PrEP or not, practising other techniques to protect against HIV infection is a great idea.

Though most people are well aware of the many prevention options, it’s still worth reminding people to:

• Use condoms when having sex.
• NEVER share needles – even with someone you love and trust.
• Get tested regularly.
• Educate yourself on how and when to take post-exposure prophylaxis (PEP).

It’s also essential to understand that PrEP doesn’t protect you against any other sexually transmitted infections (STI).

How to Get Started With PrEP

Starting on PrEP is as easy as visiting your doctor or sexual health practitioner for a discreet, non-judgemental chat.

I’ll ask you a bunch of questions about your sexual activity to help determine your risk of HIV exposure.

Typically, I’ll then order a blood test to confirm that you’re HIV-negative. At the same time, I’ll test you for hepatitis B, kidney health, and other STIs.

Your test results will be ready up to a week later. Assuming you get the all-clear (as with most people), I’ll then send a script to your phone.

Once you start taking PrEP, you’ll need to see me every three months for a sexual health check and repeat prescription if need be.

Like More Information?

For those who’d like to dig a bit deeper, there’s loads of information available on PrEP and related topics:

• pan.org.au (aka PrEP Access Now)
• endinghiv.org.au
• Thorne Harbour Health (formerly Victorian AIDS Council)
• Health Equity Matters
• Health Direct (Australian Government)
• Alfred Health

Dr Zack Bukhari is a local GP at Doctors of South Melbourne.

He is an HIV s100 prescriber and has a special interest in LGBTQIA+ health, men’s health, and sexual health.

You can make an appointment online with Zack or call us on (03) 8579 6838.