Jennifer Nguyen, PharmD Candidate

HIV weakens a person’s immune system by specifically attacking the CD4 cells, which are often called T cells. HIV can destroy so many cells over time that the body cannot fight off infections over time, leading to AIDS if left untreated.

The damage to the immune system makes the person more likely to contract opportunistic infections and other infection-related cancers before eventually succumbing to those complications. There is no effective cure that currently exists, but the disease can be controlled with proper medical care.

HIV continues to be a serious health issue for parts of the world, including the United States. At the end of 2018, an estimated 1.2 million people aged 13 years and older had HIV in the United States, including an estimated 161,800 (14%) of people whose infections had not been diagnosed. In 2018, 37,968 people received an HIV diagnosis in the United States and dependent areas.

Access to treatment is essential in reducing transmission. People with HIV who take their medication as prescribed and have an undetectable viral load can stay healthy and have effectively no risk of transmitting HIV to an HIV-negative partner through sex.

HIV-negative people can also decrease their risk for HIV. Pre-exposure prophylaxis (PrEP) is an HIV prevention approach in which people at risk for HIV (current HIV-negative individuals) take daily medicine to prevent it.

PrEP can stop HIV from taking hold and spreading throughout the body and reduce the risk of becoming infected if exposed to the virus. When taken daily, PrEP is highly effective for preventing HIV from sex or injection drug use. It is even more effective when combined with condoms and other prevention tools; however, it is much less effective when not taken consistently.

The CDC classifies HIV diagnoses into 6 transmission categories: male-to-male sexual contact (MSM), injection drug use, male-to-male sexual contact and injection drug use, heterosexual contact, mother-to-child (perinatal) transmission, and other (includes blood transfusions and unknown causes).

 Gay, bisexual, and other men who reported MSM are the population most affected by HIV accounting for 69% of the new HIV diagnoses in 2018. Heterosexuals accounted for 24% of the new diagnoses during that year and people who inject drugs (PWID) accounted for 7%.

PrEP should be considered for people without HIV who are at risk for getting the virus from sex or injection drug use. The federal guidelines recommend that PrEP be considered for HIV-negative individuals who:

had anal or vaginal sex in the past 6 months and:

Have a sexual partner with HIV (especially if the partner has an unknown or detectable viral load).

Have been diagnosed with an STD in the past 6 months

Share needles, syringes, or other equipment to inject drugs (for example, cookers).

people who have been prescribed non-occupational post-exposure prophylaxis (PEP) and

PrEP can also be an option for couples getting pregnant who have a partner with HIV as it can help protect the mother and baby from getting HIV during conception, pregnancy, or while breastfeeding.

 As long as the risk exists for the individual, adherence to the daily PrEP regimen should be maintained.

There are 2 agents currently FDA-approved for PrEP, Truvada [Tenofovir disoproxil fumarate 300 mg & Emtricitabine 200 mg (F/TDF)] and Descovy [Tenofovir alafenamide 25 mg & Emtricitabine 200 mg (F/TAF)]. Both were shown to be safe and highly effective in clinical trials.

			Tenofovir disoproxil fumarate 300 mg + Emtricitabine 200 mg (F/TDF)

			Tenofovir alafenamide 25 mg + Emtricitabine 200 mg (F/TAF)

			Note: while there is substantial published data supporting this strategy, it has 

not been reviewed by the FDA or recommended by the CDC

. The International AIDS Society of the US (IAS-USA), World Health Organization (WHO), and European AIDS Clinical Society (EACS) all endorse the option of this dosing strategy

			(24 hours before for optimal protection)			

If there is another exposure within 7 days of the last dose, take 1 tablet 2-24 hours before anal sex, then 1 tablet 24 hours after first dose then 1 tablet 24 hours after second dose

If there are continued daily sexual exposures, continue 1 tablet daily until 48 hours has passed since last sexual encounter

 been evaluated using a PrEP 2-1-1 schedule

Approved for use for all adults and adolescents ≥35 kg with indications for PrEP.

Approved for use for adults and adolescents ≥35 kg at risk for sexually acquired HIV, excluding individuals at risk from receptive vaginal/front hole sex and injection drug use only.

Articles

When taken daily, PrEP is highly effective for preventing HIV from sex or injection drug use.