PrEP for Women
August 21, 2018
While many HIV advocates believe that Truvada as PrEP is a good addition to the prevention toolbox, some people disagree. Just as adherence is a factor for people living with HIV, some are worried that HIV-negative people may not adhere to the drugs and therefore PrEP will not be effective.
There are also concerns that HIV-negative people will use PrEP instead of condoms or other safer sex measures. Although PrEP is designed to be used in addition to condoms or other HIV prevention practices, it can be taken without the agreement or knowledge of one's sex partner, for example by a woman whose male partner is not using a condom. Since condoms, when used properly, are more effective and less expensive than PrEP in preventing HIV, some believe that allowing Truvada to be used as PrEP may affect traditional HIV prevention efforts. PrEP also does not prevent sexually transmitted diseases, such as gonorrhea or syphilis.
Some women have expressed concerns about possible side effects of PrEP. The most common side effects in the studies were nausea and vomiting, which often went away after a few days or weeks. While no serious side effects were found during the studies, Truvada can occasionally cause serious effects, including kidney problems, liver problems, lactic acidosis, lipodystrophy, and bone problems. Studies in men and transgender women taking Truvada as PrEP have shown small decreases in bone mineral density (a measure of bone strength). Density returned to previous levels six months after stopping PrEP. However, these results may not apply to women who generally have lower bone mineral density than men. In the studies, another problem with Truvada was a small decrease in kidney function. This means that older people and those with kidney problems who start this drug may need to see their doctor and have lab tests more often.
If HIV-negative people take Truvada for PrEP, acquire HIV and continue to take Truvada, their virus may become resistant to that drug and similar HIV medications. This not only can reduce treatment options for these people, but may transmit Truvada-resistant HIV to others.
While we now have evidence that PrEP works to prevent getting HIV if the drugs are taken as prescribed, much more work needs to be done before PrEP becomes widely used and accepted. This includes improving health care systems so that people can get and afford PrEP, and making HIV testing more widely available, since only people who know they are HIV-negative can use PrEP safely.
PrEP is a promising tool that women can use to prevent HIV infection without their partners' cooperation. However, many questions remain. How will taking PrEP affect pregnancy and breastfeeding? How will women get tested for HIV, especially if their partners refuse to get tested? Will they be able to get PrEP if they do not know their partners' HIV status? Will a man be more likely to refuse to use a condom if he knows his partner is taking PrEP? Will women be able to keep the PrEP drugs they receive? Some women worry that their drugs might be taken away and given to another family member who is seen as "needing them more."
If you think PrEP may be a good option for you, here are a few questions you can discuss with your health care provider:
- How often -- and for how long (i.e., days, weeks) -- do I need to take PrEP if I am trying to protect myself from HIV? What happens if I miss a dose or several doses?
- What are Truvada's likely side effects and how can I manage them?
- How often will I need to be tested for HIV?
- How much will the drug cost me? Will it be covered by my insurance? Will the HIV tests also be covered by my insurance?
- Do any of my current medical conditions make Truvada not a good choice for my health overall?
- Do any of my other prescription medications, over-the-counter drugs, street drugs, herbs, vitamins, or supplements have interactions with Truvada?
- What should I do if I become pregnant while on PrEP?
There is also a good checklist at How to Talk to Your Doctor About PrEP. While PrEP is designed to be used in combination with condoms or other safer sex measures, women who cannot or do not use condoms may want to use PrEP instead of condoms. It is important to understand the overall risks and benefits of using PrEP to reduce one's HIV risk, as well as to consider methods of protection from other sexually transmitted infections or diseases (STIs or STDs).
Because studies have shown that the tenofovir disoproxil fumarate (TDF) in Truvada can lead to a reduction in kidney function and bone loss, researchers have begun testing another form of tenofovir called TAF (tenofovir alafenamide) for use as PrEP. In April 2016, the FDA approved the use of Descovy, a combination of emtricitabine and TAF, for treating HIV. A clinical trial to find out whether TAF will be as safe and effective as Truvada when used as PrEP started in November 2016.
Another HIV drug, maraviroc (Selzentry), is also being studied for PrEP. This drug does not affect bone or kidney health the way TDF does. Results so far look good.
Because some people do not want to take a pill daily, or have trouble remembering to do so, researchers have looked at a long-acting injectable form of another HIV drug, cabotegravir (an integrase inhibitor). Clinical trials for this are still in the early stages.
[Note from TheBody.com: This article was created by The Well Project, who last updated it on Aug. 17, 2018. We have cross-posted it with their permission.]
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