More About PrEP Meds image

More About PrEP Meds

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This information was prepared for you by

Jonathan Shuter, MD, a Professor of Medicine in the Division of Infectious Diseases at Montefiore Medical Center and the Albert Einstein College of Medicine

Uriel Felsen, MD, an Associate Professor of Medicine in the Division of Infectious Diseases at Montefiore Medical Center and the Albert Einstein College of Medicine

Raffaele M. Bernardo, DO, an Assistant Professor of Medicine in the Division of Infectious Diseases at Montefiore Medical Center and the Albert Einstein College of Medicine.

SUMMARY:

There are three PrEP Meds Available in the US. Two types you can take in a pill form by mouth and one type is a needle injection. All three can reduce your risk of HIV if taken according to instructions. Below, we review these medications that can help keep you safe and healthy.

TDF/FTC

  • TDF/FTC is one pill that contains two medicines and is also known as
    • Truvada
    • Tenofovir disoproxil fumarate/emtricitabine
  • Takes about a week to build up to protective levels in your system, except in the vagina where it can take three weeks
  • TDF has been used as a medicine for HIV since 2001 and FTC since 2004
    • These meds have been around for a long time
  • The combination of these two medications, TDF/FTC, has been used in the US for PrEP since 2012
    • Generic TDF/FTC has been used in the US since 2020
    • This means that the pill can look different based on which company makes it
    • Generic TDF/FTC is just as effective as “brand-name” Truvada
  • When and how to take TDF/FTC
    • It is a tablet that you take once a day, every day, if there’s a chance you could get HIV from your partner(s)
    • You can take it with or without food

Side Effects

  • TDC/FTC has very few side effects | In fact, most people will have no significant side effects
  • Stomach
    • Sometimes TDC/FTC can upset your stomach
    • Unless it is making you very sick, this side effect usually passes after two to four weeks if you stay on the medicine
  • Kidney (also known as renal)
    • Side effects are very rare
    • Your healthcare professional will want to do a blood test every six to twelve months to check your kidneys
    • If there is a kidney problem on TDF/FTC, it usually gets better after stopping the medicine
  • Thinning of bones
    • Side effects are very rare but can also occur
    • TDC/FTC does not usually cause pain
    • Taking calcium and vitamin D pills may help to avoid bone side effects

TAF/FTC

  • TAF/FTC, similar to TDC/FTC, is one pill that contains two medicines and is also known as
    • Descovy
    • Tenofovir alafenamide/emtricitabine
  • Takes about a week to build up to protective levels in your system
  • TAF has been used as a medicine for HIV since 2015 and FTC since 2004
    • These meds have been around for a long time
  • TAF/FTC has been used in the US for PrEP since 2019
  • TAF/FTC is ONLY approved for use by
    • Cisgender men
    • Transgender women
    • It is not known whether it works in cisgender women since its ability to prevent HIV in the vagina is uncertain
  • When and how to take TAF/FTC
    • Taken the same way as TDF/FTC
    • One pill once per day, if there’s a chance you could get HIV from your partner(s)
    • You can take it with or without food

Side Effects

  • TAF/FTC has very few side effects | In fact, most people will have no significant side effects
  • Stomach
    • Sometimes it can upset your stomach
    • Unless it is making you very sick, this side effect usually passes after two to four weeks if you stay on the medicine
  • Kidney and bone effects
    • TAF/FTC probably has fewer kidney and bone side effects than TDF/FTC
    • Your healthcare professional will want to do a blood test every six to twelve months to check your kidneys
    • Taking calcium and vitamin D pills may help to avoid bone side effects

Note: You don’t have to take PrEP pills at exactly the same time every day | It’s more important that if you’re taking oral PrEP you make sure to get it in your system every day

Cabotegravir

  • Cabotegravir injection is also known as
    • Apretude
    • CAB-LA
  • Cabotegravir has been used in the US as a medicine for HIV since January 2021
  • In December 2021, cabotegravir was approved for PrEP as a long-acting injection every two months
    • The protection that you get from cabotegravir every two months is at least as good as taking TDF/FTC or TAF/FTC every day
    • One of the best things about cabotegravir is that you get the injection every two months, and you don’t have to worry about taking pills
  • If you decide to take cabotegravir PrEP
    • You will have to see your healthcare professional every two months for the injection
    • If you’re worried you might miss an injection, you should speak to your healthcare professional
  • To start cabotegravir PrEP
    • You either have to get an injection every month for the first two months or
    • You can take cabotegravir pills every day for a month before switching to an injection every two months
  • It is not known how long you have to wait after your first injection until you are protected
    • It would make sense to wait seven days as is done for the other types of PrEP
    • If you are switching from TDF/FTC or TAF/FTC to cabotegravir, you do not have to wait
  • The cabotegravir injections must be given in the buttocks

Side Effects

  • In general, cabotegravir is considered safe
  • The only common side effect is pain or swelling where you get the injection
  • This usually happens less and less as you stay on the drug
  • You can take over the counter pain relievers (like Tylenol) and/or use heating pads to relieve the pain
  • It is rare for people to stop cabotegravir because of the pain

Other Things You Should Know

  • What if you don’t want to take a pill every day?
    • Depending on how frequently someone is at risk for HIV, taking a pill every day may not be the best option
    • People with less frequent risk who have decided to take TDF/FTC may talk to their provider about the possibility of “on-demand” or “2-1-1” PrEP instead of taking a pill every day
    • This is an option that has only been recommended for men who have sex with men, and you should discuss it with your provider if you don’t want to take a pill every day
  • Switching from one PrEP drug to another
    • If you want to switch from one PrEP medicine to another, it can probably be done safely, but it is something that you should discuss with your healthcare professional to make sure it is done safely and correctly
  • Stopping and restarting PrEP
    • You might consider stopping PrEP if you are no longer at risk for HIV
    • Remember that once PrEP is stopped, you will no longer have protective levels of the medication in your system
    • If you stop PrEP, you will need an HIV test first to make sure it is negative before you can restart

Learn More – Primary Sources

There are many good websites with information people interested in learning more about PrEP. Here are a few:

CDC: PrEP (Pre-exposure Prophylaxis)

NIH: Pre-Exposure Prophylaxis

International Association of Providers of AIDS Care (iapac.org): Pre-Exposure Prophylaxis (PrEP)

New York State Department of Health

PleasePrEPMe (California State)

CDC: PrEP Is for Women

Commercial Support

This educational activity is supported by an independent educational grant from Gilead Sciences

Faculty Disclosures

Dr. Shuter has no relevant financial relationships to disclose

Dr. Felsen has no relevant financial relationships to disclose

Dr. Bernardo has no relevant financial relationships to disclose