What is PrEP?

We at GMJ understand there is no easy way to approach this controversial little blue pill without offending someone. Right now, you most likely have a strong opinion, for or against, the very existence of Truvada as a method to prevent HIV infection.

Our goal in this Piece is not to change your mind, rather to provide accurate and up-to-date facts and research results for those with questions or seeking more information. If you are one that does not agree with PrEP, just don’t take it, but please allow others to make informed decisions for themselves.

But, before we get into the meat of this topic, we would like to set a standard of understanding. The first being that you, the reader, agrees that no one person or persons has the right to restrict access to any medication which has been approved by the FDA and/or CDC for general usage, by way of “slut shaming”, bullying or abuse. The second is that we all have opinions, experiences and personal anecdotes, which influence and affect our individual lives, that may not work well for others. Finally, an individual’s choice regarding his sexual healthcare and treatment, are private and personal matters that are to be addressed between him, his doctor(s) and his sexual partners.

Let’s begin,

What is Truvada?

Truvada, (the brand name) is a once daily medication, comprised of two drugs, Viread and Emtriva, marketed by Gilead Sciences, and originally approved for the treatment of the HIV virus in August of 2004. In July of 2012 its use was expanded to a pre-exposure prophylaxis (PrEP) for those with a high risk for HIV infection. Though its usage as a preventative medication is still relatively new, the medication itself and its ability to successfully combat the HIV virus is not. The drug has been deemed extremly safe for general use, with few side effects and amazingly effective in beating back the virus to undetectable levels. Truvada, like many long term medications, has been reformulated a couple of times to reduce the short and long term side effects, with a newer version projected to hit the market in 2016/2017. Currently, Truvada is the most widely prescribed medication to treat HIV.
red ribbonIn addition to this, the amount of medication prescribed for PrEP usage is the same as for those with HIV but without the need of an additional HIV medication, usually a protease inhibitor. As of this writing, January of 2016, Truvada is the only medication approved by the FDA for usage as PrEP but other pharmaceutical companies are in the development and testing phases for newer options.

Are there any side effects?

There are very few medications, if any, that have hit the public market that did not have some level of side effects for at least a portion of the population. This includes everything from aspirin to cough syrup; Truvada is no different. And when a manufacturer lists side effects, these are possibilities and not everyone who takes this medication will receive them, and/or if they do, with any level of severity.

Everyone’s body is different and medications work differently inside of each of us. If you find yourself on the receiving end of side effects, before stopping any medication, check with your doctor for possible remedies.

When considering side effects, let’s take a look at a dual breakdown of temporary and possible long-term effects, keeping in mind that unlike someone who is HIV positive, taking PrEP is a lifestyle choice that can be changed at any moment, and then restarted at a later date, under a doctor’s care.

Possible Temporary Side Effects (as reported by at least 2% )

* Nausea,

* Abdominal cramping,

* Vomiting,

* Dizziness,

* Headache,

* Diarrhea,

* Back Pain,

* Depression,

* Anxiety,

* Fatigue.

* Weight loss

If these symptoms occur, it will be within the first week or two of beginning a PrEP routine, but pass quickly without medical treatment or lasting affects. Many over the counter medications can treat these ailments swiftly. These are also known as “start-up symptoms”, common with many medications.

We at GMJ strongly suggest taking the first pill on a Friday night, if you don’t work weekends, so that you may manage any possible side effects. Also, for many, milk and dairy products are known to aggravate the nerves in the stomach and cause tummy troubles when beginning a PrEP routine.

Possible Long-Term Side Effects

* Low Bone Density

* Chronic Kidney Disease

Long-term side effects are very rare, and if they do begin, should be caught by your treating physician before they become chronic or threatening, in one of your three (3) month check ups. Stopping PrEP is known to stop and even reverse any side effects. The two listed above are the side effects which seem to cause the greatest concern, but there are a great deal of factors which may increase one’s risk, beyond just the medication itself.

Generally speaking, Blacks are at a higher risk for kidney disease than whites, and those guys positive with sexually transmitted illnesses such as HEP C, are also known to be at a greater risk for kidney disease and changes in their bone density. The point is, side effects are individual experiences that are based on a person’s full lifestyle, medical history and ethnic background. No two people are the same, and experiencing side effects is not guaranteed when taking PrEP. Just because someone else experienced a side effect, either temporary or long-term, does not mean it will happen to you.

The following chart by Mark Mascolini, of The Center for AIDS, should shed some light on the issue of possible long-term side effects.

Classic Risk Factors for Low Bone Mineral Density and Chronic Kidney Disease
Low Bone Density Risk FactorsChronic Kidney Disease Risk Factors
Demographics/family history
Older ageOlder age
White raceBlack race
Asian raceAsian race
Female sexNative Americans
Previous fragility fractureFamily history of chronic kidney disease
Family history of osteoporosis 
Physical factors
Low weightOverweight
Low estrogen or testosterone 
Thyroid problems 
Physical inactivity 
Dietary and related factors
Vitamin D deficiency 
Limited sun exposure 
Low dietary calcium 
Other conditions and medications
Diabetes mellitusDiabetes mellitus
HCV infectionHCV infection
Chronic infectionHigh cholesterol
Chronic kidney diseaseHypertension
Corticosteroids (such as prednisone, cortisone)Cardiovascular disease
Anticoagulants, anticonvulsants, antipsychotics, cyclosporines, glitazones, gonadotropin-releasing hormone agonists, methotrexate, proton pump inhibitorsKidney stones or kidney infection; sickle-cell anemia; autoimmune disorders (such as lupus, scleroderma)
Sources: Centers for Disease Control and Prevention. National chronic kidney disease fact sheet 2010. Gupta SK, Eustace JA, Winston JA, et al. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2005;40:1559-1585. McComsey GA, Tebas P, Shane E, et al. Bone disease in HIV infection: a practical review and recommendations for HIV care providers. Clin Infect Dis. 2010;51:937-946. Mayo Clinic. Osteoporosis. Mayo Clinic. Chronic kidney failure. National Institutes of Health. US National Library of Medicine. Medline Plus. Osteoporosis. National Institutes of Health. US National Library of Medicine. PubMed Health. Chronic kidney disease.

NOTE: When weighing the fear of possible side effects, long and short term, with the usage of PrEP, you should also think about your overall risk factors for contracting HIV and if you believe your risk is worth the protection. Only you can make this decision for yourself.