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These declines were mild, stabilized after several weeks of being on the drug, and reversed once the drug was discontinued. Retrieved 7 February 2018.

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Tablets of Truvada, the combination used for HIV pre-exposure prophylaxis Pre-exposure prophylaxis PrEP is the use of drugs to prevent disease in people who have not yet been exposed to the disease-causing agent. The term typically refers to the use of as a strategy for the. PrEP is one of a number of prevention strategies for people who are HIV negative but who also have higher-than-average risk of contracting HIV, including sexually active adults at increased risk of HIV e. Patients on PrEP take Truvada every day and must also agree to see their healthcare provider at least every three months for follow-up testing. When used as directed, PrEP has been shown to be highly effective at reducing the risk of contracting HIV. PrEP is intended for use along with other risk reduction strategies such as because people taking PrEP are still at some risk of contracting HIV, especially those who do not take PrEP consistently, and because people on PrEP remain at risk for other types of. Often, lab testing is required before starting PrEP, including a test for HIV. Once PrEP is initiated, patients are asked to see their provider at least every three to six months. PrEP has been shown to be effective at reducing the risk of contracting HIV in individuals at increased risk. However, PrEP is not 100% effective at preventing HIV, even in people who take the medication as prescribed. There have been several reported cases of people who despite taking PrEP became infected with HIV. People taking PrEP are recommended to use other risk reducing strategies along with PrEP, like condoms. If someone on PrEP contracts HIV, they may experience the. Research has shown that PrEP is generally safe and well tolerated for most patients, although some side effects have been noted to occur. Research has shown that the use of Truvada as PrEP has been associated with mild declines in kidney function. These declines were mild, stabilized after several weeks of being on the drug, and reversed once the drug was discontinued. No data In the United Kingdom, Scotland was the only nation to approve the use of PReP Approval for use Truvada was previously only approved by the US to treat HIV in those already infected. In 2012, the FDA approved the drug for use as PrEP, based on growing evidence that the drug was safe and effective at preventing HIV in populations at increased risk of infection. In 2012, the issued guidelines for PrEP and made similar recommendations for its use among men and transgender women who have sex with men. Funded access to PrEP will require that people undergo regular testing for HIV and other sexually transmitted infections, and are monitored for risk of side effects. People taking funded PrEP will receive advice on ways to reduce the risk of HIV and sexually transmitted infections. In Australia, the country's approved the use of Truvada as PrEP in May 2016, allowing Australian providers to legally prescribe the medication. The drug begins being listed on the PBS from 1 April 2018. Availability and pricing In the United States, PrEP is available only by prescription. Patients interested in learning more about PrEP can contact their healthcare providers. Emory University hosts a search engine to help US patients with or without insurance find healthcare providers who can prescribe PrEP. PrEP drugs can also be expensive, with tremendous variation in cost across different countries. Multiple programs exist to help make PrEP more accessible to those who might benefit from the drug. In 2015, the US CDC published guidelines to help American patients figure out how to pay for PrEP. Those with health insurance can find out from their health insurer whether PrEP and the associated costs e. Those without health insurance or for whom health insurance has declined to pay for PrEP may be eligible for free PrEP from the drug's manufacturer, Gilead. A similar program exists to reduce or eliminate the cost of the copayment for PrEP among insured patients, also sponsored by Gilead. Others turn to online pharmacies to access cheaper generic versions of PrEP. For instance, a dramatic decline in new HIV infections in London, UK in 2016 has been attributed by some to access to PrEP through online pharmacies, although others have expressed concerns about the safety and reliability of accessing PrEP through such online pharmacies. Politics and culture Since the FDA approval of PrEP for the prevention of HIV, moves toward greater adoption of PrEP have been met with controversy, especially around the overall public health effect of widespread adoption, the cost of PrEP and associated disparities in availability and access. Many public health organizations and governments have embraced PrEP as a part of their overall strategy for reducing HIV. For example, in 2014 New York state governor initiated a three-part plan to reduce HIV across New York that specifically emphasized access to PrEP. The campaign aims to dramatically reduce the number of new HIV infections in the city and relies on expanding access to PrEP as a key strategy for achieving that goal. Public health officials report that since 2013 the number of new HIV infections in San Francisco has decreased almost 50% and that such improvements are likely related to the city's campaign to reduce new infections. Additionally, numerous public health campaigns have been launched to educate the public about PrEP. For instance, in New York City in 2016 launched an ad campaign in bus shelters across the city reminding riders that adherence to PrEP is important to ensuring the regimen is maximally effective. Despite those efforts, PrEP remains controversial among some who worry that widespread PrEP adoption could cause public health issues by enabling risky sexual behaviors. For instance, founder and director Michael Weinstein has been vocal in his opposition to PrEP adoption, suggesting that PrEP causes people to make riskier decisions about sex than they would otherwise make. Some researchers, however, believe that there is insufficient data to determine whether or not PrEP implementation has an effect on the rate of other sexually transmitted infections. Other critics point out that despite implementation of PrEP, significant disparities exist. For example, some point out that African Americans bear a disproportionate burden of HIV infections but may be less likely than whites to access PrEP. Still other critics of PrEP object to the high cost of the regimen. For example, the U. However, following significant advocacy efforts, the NHS has started to offer PrEP to patients in the UK in 2017. Initial studies of PrEP strategies in non-human primates showed a reduced risk of infection among animals that receive ARVs prior to exposure to a simian form of HIV. In 2008, the study demonstrated 42% reduction of HIV infection among men who have sex with men, and subsequent analysis of the data has suggested that 99% protection is achievable if the drugs are taken every day. Below is a table summarizing some of the major research studies that demonstrated PrEP with Truvada to be effective across different populations. PrEP approaches with agents besides oral Truvada are being investigated. There has been some evidence that other regimens, like ones based on the antiretroviral agent , could potentially prevent HIV infection. Similarly, researchers are investigating whether drugs could be used in ways other than a daily oral pill to prevent HIV, including taking a long-acting PrEP injection, PrEP-releasing implants, or rectally administered PrEP. However, it is important to keep in mind that as of 2017 major public health organizations such as the US Centers for Disease Control and the World Health Organization recommend only daily oral for use as PrEP. Centers for Disease Control. Retrieved 15 December 2017. Retrieved November 29, 2017. Retrieved 5 December 2017. Retrieved 15 December 2017. Annals of Internal Medicine. Topics in Antiviral Medicine. Retrieved 15 December 2017. Retrieved 15 December 2017. PDF from the original on 2016-12-21. Retrieved 15 December 2017. Retrieved 18 December 2015. Retrieved 12 January 2017. Australian Federation of AIDS Organizations. Retrieved 15 December 2017. Retrieved 12 January 2017. Retrieved 15 December 2017. Retrieved 12 January 2017. Retrieved 15 December 2017. 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