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Truvada as extra protection.
Jan 23, 2013

I have been reading about Truvada and how combined with a properly worn condom will offer 99.9% protection against contracting the virus. I would like to know if one can put on a condom and pop a pill of truvada prior to having sex and thus be properly protected. Also, are there any serious side effects of truvada for a negative person?

Response from Dr. Wohl

Using a condom properly provides just about the level of protection you are seeking. Sure, condoms can break and if that goes unnoticed then what was safe becomes unsafe. Therefore, some like the idea of a belt and suspenders approach to safe sex.

Pre-exposure Prophylaxis, also called PrEP, can act as a sort of chemical condom. The idea is that with HIV medications on board, if a wily virus wanders across one of your mucous membranes it would encounter the drugs and, zap, be stopped in its tracks.

A study of Truvada (which is two medicines in one pill) in high risk men who have sex with men found that DAILY use of the drug did reduce risk of acquiring HIV. However, some men in the treatment arm did get infected, likely because of poor adherence to the medication.

So, to get best protection from Truvada it likely has to be taken every day - and even then may not be 100% protective. Animal studies suggest there may be viable less frequent dosing options but almost all these studies show you need to build up levels of the drugs in the system before sex for it to prevent infection. That is the drug needs to be taken for a few days prior to exposure - popping a Truvada and an hour or two later having unprotected sex will not offer any protection. Worse, if you take the drug intermittently you could end up with drug resistant virus if you take it after becoming unwittingly infected.

Side effects of Truvada in the study of HIV- men were nausea and weight loss. In some HIV+ people the drug can put a strain on the kidneys. Bone density can drop after starting the drug.

The drug also costs money. Depending on where you are and your insurance situation the cost may be prohibitive.

Truvada is an option. Its should be used under the guidance of a medical professional who understands its use as PrEP. Monthly HIV testing for those using the drug alone as PrEP is prudent. Lastly, Truvada does not protect against other STIs such as syphlllis, gonorrhea, chlamydia or hepatitis C.

DW



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