PEP, PrEP, & TasP:
Terms Everyone Should Know
Where we were, we are, and where we are going.
AIDS made the New York Times on July 3, 1981 with the article “Rare Cancer Seen in 41 Homosexuals”. We did not isolate the HIV virus until 1983 and did not have a screening test for it until 1985. We had our first mildly effective yet toxic medication Retrovir (AZT) in 1987. Effective treatment finally occurred in 1995 with three drug therapy.
Before 1995, I held a lot of hands and attended a lot of funerals for my patients and friends. Now I am attending weddings and baby showers for my patients and friends. AIDS is no longer a death sentence and people living with HIV can have a normal life and normal life span.
Treatment for HIV has lead to treatment to prevent HIV. These treatments are now known as PEP, PrEP, and TasP.
• PEP or Post-Exposure Prophylaxis is the term for using HIV medications after a potential exposure to reduce the risk of HIV infection.
• PrEP or Pre-Exposure Prophylaxis is the term for using HIV medications before exposure to reduce the risk of HIV infection.
• TasP or Treatment as Prevention is the term referring to HIV positive people taking their HIV medications properly and thus reducing the risk of transmission to others.
Let’s discuss each of these important in a little more detail.
PEP usually involves taking a combination of three specific drugs for 30 days the very early use of HIV drugs can stop an individual from becoming HIV positive. These are generally the same medicines that are used to treat HIV and must be started as soon as possible after an exposure event. Starting within the first 2- 3 hours provides more than 95% protection. Most guidelines have a cut off at 48 hours as the protection offered drops below 36% at 72 hours. Unlike Europe and Great Britain where PEP is available 24/7 in the emergency departments and urgent cares, currently North Carolina emergency departments and urgent cares do not offer PEP, unfortunately. I am not certain why, but I suspect there is a need for more education in our medical community. PEP is also useful if a shared needle is the risk factor for HIV. Before getting PEP you will need to talk about your risk. This involves talking about the type of sex or type of exposure, and whether you know the HIV status of your partner. You will also need a rapid HIV test to make sure you are not positive before starting PEP. Finally there may be mild but manageable side effects such as a queasy stomach or diarrhea. These are not common.
PrEP uses two drugs to reduce the risk of acquiring HIV and is taken daily. Truvada, a combination of two drugs has been approved for 3 years now for PrEP and more than 10 years for use in treating HIV. In a 2007 ongoing study sponsored by the US National Institutes of Health (NIH), the iPrEx study showed those individuals who took Truvada everyday had a protection rate of 96% which is as good as using condoms every time. It has been suggested that the protection rate may be higher. For good reason, the CDC guidelines continue to recommend condom use as further protection against HIV and STDs. Please remember Truvada only reduces the risk of HIV and does not help against any other STDs, such as gonorrhea, Chlamydia, trichomonas, syphilis, genital warts, etc. The U.S. news magazine TIME called the iPrEx Study results “the most significant medical breakthrough of 2010” and President Obama publically lauded the outcomes of the iPrEx study. PrEP with Truvada is covered by almost all insurance plans. Gilead, the makers of Truvada, has a generous patient assistance program for those uninsured and underinsured. For more information or to start PrEP, contact us at Rosedale Infectious Diseases.
TasP refers to HIV positive people using HIV treatment not only for their own health, but also to reduce the risk of transmission to others. It also means everyone who has HIV needs to be on medications. We have long known that HIV positive individuals who take their medications every day were living healthier longer lives and were less likely to pass on HIV to others. Several studies going back to 2008 have shown decreased new infection rates in cities where TasP was implemented. The PARTNER Study followed 1140 sero-discordant couples (one positive and one negative), which was released in March 2014, revealed dramatic new information. When presenting the results and asked what the study tells us about the chance of someone with an undetectable viral load transmitting HIV, presenter Alison Rodger said: “Our best estimate is it’s zero.” The study followed 1140 committed couples, 60% straight and 40% gay for two years. In those two years these 1140 HIV positive individuals took their medications every day and kept their viral loads less than 200. Their HIV negative partners who were not on PrEP had no outside sex partners. No condoms were used. Over 32,000 episodes of rectal and vaginal intercourse occurred. The gay guys accounted for more than half of all sexual events. Sorry straight allies! At the end of the two year study, how many the HIV negative partners contracted HIV? None. Zip. Nada. The new paradigm may be that undetectable is the new negative! The PARTNER study is still recruiting gay male couples and its full results will be available until 2017. For more information, go to: www.clinicaltrials.gov and search for the PARTNER Study or contact us at Rosedale Infectious Diseases.
The CDC has changed the language in its safer sex education material. Because Truvada offers protection as good as or better than condoms against HIV, unprotected sex is not the same as condomless sex. The CDC no longer uses the word unprotected when referencing sex without a condom. Truvada offers protection from HIV and now the CDC guidelines uses the word condomless sex instead of unprotected sex. Remember Truvada does not offer protections from other STDs.
And please remember your PrEP should include the following::
• Use condoms
• Get HIV tested regularly
• Get tested for other sexually transmitted infections
• Get harm reduction education
• Reduce one’s number of sexual partners
Finally as a reminder, the CDC states that approximately 20% of individuals who are positive for HIV don’t know it and are responsible for over 75% of all new infections! Get tested and know your status. Rosedale Infectious Diseases offers free HIV testing Monday through Friday.
These are exciting times indeed!