PrEP: New and Continuation

PrEP (Pre-exposure Prophylaxis) “Descovy”

Florida has one of the highest annual rates of new HIV infection in the country. Most often it is passed through sexual transmission, especially among men who have sex with men. Safe sex practices and faithful condom use are essential, but clearly not practiced enough to stop all new cases. Sexually active individuals are still taking risks and getting HIV. Those at greatest risk are individuals with high numbers of anonymous sex partners, those that are receptive in anal sex (“bottoms”), those who are making poor decisions while high or drunk and those with a history of multiple STD’s. Those at increased risk also include those partnered with someone with HIV who may not be taking their medications faithfully or have developed resistance.

In 2012 the CDC began to promote PrEP as an additional way to reduce new HIV infection. PrEP initially involved the once a day use of a medication called Truvada by individuals proven to be HIV negative. Truvada is a combination pill containing two anti-HIV medications. For most patients, it is easy to take and has very few side effects. It has been shown to be highly effective (over 90%) in preventing HIV if taken faithfully and used with other risk-reduction practices. Rarely it can reduce kidney function, but close follow-up can detect any negative impact.

In October 2019, Truvada was replaced by Descovy, a new formulation of the same two medications. Descovy has been shown to be equally effective and has lower risk of the side effects related to Truvada. It is dosed once a day in the same manner as Truvada.

Another important fact about PrEP is that most patients can obtain it at little to no cost. It is covered by most insurances. The manufacturer, Gilead, provides cards to cover any additional insurance co-pays. Gilead also makes the medication available to those who are uninsured via a patient assistance program. Fear of cost is therefore not a reason to avoid PrEP.

Our PrEP visits include an initial HIV risk assessment and personalized recommendations for reduction of exposure. We then draw complete laboratory studies in our office to check baseline kidney function as well as to confirm a client is negative for both HIV and hepatitis B. These labs are covered by insurance as well. Descovy prescriptions are given at the first visit to be filled at a local pharmacy or via mail order. Repeat assessments of risk and collection of lab tests are then collected every 3 months. We also highly recommend complete STD screening at the first and every follow-up visit.

PrEP does not need to be a long-term commitment. Individuals’ sexual practices and relationships change over time. If one is no longer at risk, PrEP can be discontinued. If things change and it is needed again, it can be resumed with not loss of effectiveness, upon discussion with your provider.

Please call us at 813-518-0881 if you want to learn more, want to start Descovy or are already taking Truvada and want to switch to Descovy.