Pre-Exposure Prophylaxis (PrEP): Seven things you did not know about Truvada

Sex workers used to illustrate the story. {PHOTO CREDIT: Daily Post Nigeria]
Sex workers used to illustrate the story. {PHOTO CREDIT: Daily Post Nigeria]

Truvada is a pill used for Pre-Exposure Prophylaxis (PrEP), a practice of using antiretroviral drugs to prevent HIV infection.

PREMIUM TIMES had earlier reported that many Nigerians do not know about the drugs and its importance.

PBS NEWS HOUR, an American news site, has highlighted some important things to know about the drug, Truvada

Here are Seven of them:
1. Truvada has been used to treat HIV for a decade

Truvada is a combination of two medicines, emtricitabine and tenofovir. It has been used for ten years as part of a drug regimen that suppresses HIV in people already suffering from the virus.

Truvada works by blocking an enzyme called reverse transcriptase, which HIV uses to copy its genetic material and reproduce. In addition to suppressing HIV in people who have already been infected, Truvada can also prevent the virus from infecting people in the first place.

2. PrEP can reduce the risk of HIV infection by more than 90 percent if used properly, but is far less effective if not taken as recommended.

PrEP is recommended for people at high risk of HIV infection. In practice, this mostly applies to gay or bisexual men who have had anal sex without a condom or been diagnosed with a sexually transmitted disease (STD) in the past six months. But it also includes intravenous drug users who share equipment and heterosexual men and women who do not regularly use condoms during sex with high-risk partners.

3. Some fear widespread use of PrEP could contribute to the spread of other STDs

PrEP has been criticised by some public health experts, most notably AIDS Healthcare Foundation President Michael Weinstein, who has called Truvada “a party drug,” arguing that it will encourage irresponsible sexual practices.

Mr Weinstein and other critics fear that Truvada will provide people with a false sense of security, leading to decreased condom use, riskier sex and an increase in the transmission rates of STDs like syphilis and gonorrhea.

Critics also fear that people will not take the medication reliably, as is required for maximum protection.

Truvada is intended to be used along with condoms, not in place of them, and doesn’t protect against other sexually transmitted diseases.

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4. PrEP has not been as widely adopted as public health officials expected.

When PrEP was first declared a viable treatment, many public health officials expected a stampede of people demanding the drug.

Robert Grant, the lead scientist of the 2010 National Institutes of Health study that demonstrated Truvada’s efficacy in preventing HIV transmission, said this to The New Yorker:

But despite the fact that an estimated half million Americans could be good candidates for PrEP treatment, relatively a few actually take Truvada.

The drug’s manufacturer, Gilead Sciences Inc., said that in reviewing records from about half of U.S. pharmacies that dispensed Truvada between January 1, 2012, and March 31, 2014, it found that only 3,253 people had started the PrEP regimen during that period.

Various factors have been cited as contributing to the low numbers of people using PrEP, including criticism from groups like the AIDS Healthcare Foundation, the drug’s high cost and the fact that Gilead has not actively marketed the drug for use in preventing HIV.

5. Truvada use has been stigmatised by some members of the gay community

Another possible reason for Truvada’s limited use is that PrEP users have been criticised by some in the gay community, who have labeled them “Truvada whores.”

These critics argue that many who use the drug see it as en excuse to engage in unsafe sexual practices, and that encouraging people to use PrEP is tantamount to giving them permission to have sex without condoms.

6. Truvada is expensive

In the USA, Truvada costs about $1300 per month without insurance. In Nigeria, the price cannot be ascertained but the drug is said to be very expensive.

7. Truvada has some negative side effects.

Truvada can have a number of adverse side effects, including lactic acidosis, a dangerous buildup of lactic acid in the bloodstream, liver problems, kidney issues — including kidney failure — and bone density loss.

So far, no evidence of bone density loss had been found in people taking Truvada to prevent HIV, though it has been seen in those who take it to suppress the virus.

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