PrEP Information
1. What is PrEP?
PrEP (short for Pre-Exposure Prophylaxis) is a once-a-day pill that prevents HIV. The medication works to prevent HIV from establishing infection inside the body.
HIV PrEP has two main components: emtricitabine and tenofovir-disoproxil-fumarate. These components are also used as treatment by people who have HIV. Although PrEP prevents HIV, it does not prevent other STIs, like syphilis, gonorrhoea, chlamydia etc.
It’s important to understand PrEP is part of what’s called ‘combination prevention’, which is the best method to prevent HIV and STIs. Combination prevention involves the use of multiple strategies that have each been proven to work:
Pre-Exposure Prophylaxis (PrEP)
Post-Exposure Prophylaxis (PEP)
HIV Treatment
Sexual health education
Needle distribution programs and safe consumption sites
Anti-poverty work, housing efforts
Sex Work decriminalization and protections
Condom use
2. How does it work?
Rather than a physical barrier such as condoms, PrEP is a chemical barrier. It prevents the HIV virus from replicating in the body, leading it to die out and not get a hold of a person’s immune system. Essentially, PrEP works by preventing the HIV virus from reproducing, thereby preventing HIV transmission.
Like any barrier, PrEP needs to be strong enough before it can prevent HIV, usually that means being on PrEP for 7 days for anal sex and 21 days for vaginal sex. These timelines allow the PrEP components to be absorbed by different tissues in the body.
3. How effective is PrEP?
PrEP is around 99% effective when taken as prescribed. Usually, PrEP is prescribed as a daily pill, to be taken everyday, once a day. Some choose to take PrEP differently, opting for ‘on-demand’, or ‘event-based’ PrEP. This regimen involves taking 2 pills 2-24 hours before HIV-transmissible contact and then 1 pill daily, for two days after (nicknamed the 2-1-1 method). This method is also effective, although less so than everyday PrEP since PrEP’s effectiveness is directly correlated to adherence (taking medication as prescribed).
4. Is PrEP right for me?
PrEP is recommended for people with the highest risk of acquiring HIV, including (but not limited to):
Men who have sex with men and transgender women
Heterosexual women and men who have high-risk exposure, such as having a partner with HIV, sex workers, or having sex with a person at high risk for HIV
People who inject drugs
People whose condom use is inconsistent
So all in all, PrEP should be considered by those who are HIV negative and at higher risk for HIV. The decision to be on PrEP is made between patient and healthcare provider. A clinician will assess your HIV risk, and ask questions about your sexual and drug-use behaviour to determine if you’re a suitable PrEP candidate.
Some exams (bloodwork and urine) are required prior to initiating PrEP. These tests are necessary to ensure you remain HIV negative, that your body is tolerating PrEP well, and that you’re being tested and treated for STIs.
5. Truvada vs. Generic Truvada
A lot of people know PrEP as Truvada, while many are only familiar with PrEP.
HIV PrEP and Truvada and generic truvada are all (mostly!) interchangeable.
Truvada: a drug (combination of Tenofovir disproxil fumarate 300 mg/Emtricitabine 200mg) invented by the US pharma company Gilead Sciences back in 2001. It costs about $2000/month in the US!
Generic truvada: After the research, development, and marketing of a new drug like Truvada, companies such as Gilead Sciences are given a patent to exclusively sell the drug for a certain period of time. The company can also determine the prices charged for the medication. After that period of time, other manufacturers have the right to create and sell a generic version of the same drug, which include the exact same components. With generics, you get the exact same drug, but at lower costs. Gilead Sciences made a deal with pharmaceutical manufacturer Teva to begin manufacturing generic truvada for Canadians. This is the exact same drug as Gilead’s Truvada, just a fraction of the cost. It was approved for use in Canada in 2016 by Health Canada. There are now four different generic pharmaceutical companies that offer PrEP in Canada. The price is around $250/month, but it is covered for many Canadians through provincial insurance, and is covered by most private insurance drug plans.
HIV PrEP: Technically PrEP is not a drug. It is a treatment modality - the idea of taking a drug before getting a disease to reduce your risk of acquiring it. Right now, Truvada and generic truvada are the most commonly used drugs for PrEP and so the terms are used interchangeably. That being said, there are a few other drugs used for HIV PrEP (the main one being Descovy), and more being researched. Generic truvada is the only drug covered by provincial plans and most private insurance plans given it is 99% effective and (relatively) affordable.
6. Side Effects
PrEP may present some short term side effects like nausea, headaches, and stomach aches. In general, less than 10% of PrEP patients experience any side effects, and if they do, they tend to cease after a week. With regards to long term side effects, PrEP has been shown in some patients to lead to a decrease in bone mineral density, as well as kidney function - however they don’t cause complications unless patients have a pre-existing condition (which would be screened through lab work before PrEP initiation). The levels of bone and kidney health also return to normal levels after somebody stops PrEP.
That’s why PrEP requires lab testing every three months - just to make sure your body is tolerating PrEP well. If there are any issues, your clinician will help you manage them to keep you safe.
8. How do I get PrEP?
Like with any prescribed medication, there are some steps one needs to take before starting on PrEP:
Speak to a clinician. A clinician visit will assist you in determining if PrEP is right for you. They will ask about your sexual activity, drug use, and any other behaviour that may put you at higher risk for HIV. Clinicians will also instruct you on the necessary tests before you get your prescription and answer any questions you may have
Get your lab work done. Initial lab work tests your HIV status, STIs, and kidney function to ensure you’re suitable for PrEP. Given the results come back as expected, you can receive your 30-day PrEP prescription
Repeat lab work after 1 month and then every 3 months. This is done to ensure you’re tolerating PrEP well, remain HIV negative, and any STIs are detected and treated