What is PrEP?

PrEP (pre-exposure prophylaxis) is medicine that reduces your chances of getting HIV from sex or injection drug use. When taken as prescribed, PrEP is highly effective for preventing HIV.

Are there different types of PrEP?

PrEP can be pills or shots.

There are two pills approved for use as PrEP: Truvada® and Descovy®.

• Truvada® is for people at risk through sex or injection drug use.
• Descovy® is for people at risk through sex. Descovy is not for people assigned female at birth who are at risk for HIV through receptive vaginal sex.

Apretude is the only shot approved for use as PrEP. Apretude is for people at risk through sex who weigh at least 77 pounds (35 kg).

Can I switch from pills to shots?

Talk to your health care provider about switching from PrEP pills to shots. PrEP shots may be right for you if you do not have HIV and have no known allergy to the medicines in the shot.

If you decide to switch from PrEP pills to shots, you’ll need to visit your health care provider regularly to receive your shot. You’ll also need to be tested for HIV prior to each PrEP shot.

Is PrEP safe?

• PrEP is safe, but some people experience side effects like diarrhea, nausea, headache, fatigue, and stomach pain. These side effects usually go away over time.
• Tell your health care provider about any side effects that are severe or do not go away.
• Learn more about side effects from Truvada, Descovy, and Apretude.

What is PrEP?

PrEP, or pre-exposure prophylaxis, is medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use. PrEP can stop HIV from taking hold and spreading throughout your body.

Currently, there are two FDA-approved daily oral medications for PrEP. A long-acting injectable form of PrEP has also been approved by the FDA.

Why Take PrEP?

PrEP is highly effective at preventing HIV when taken as indicated.

PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed. Among people who inject drugs, it reduces the risk by at least 74% when taken as prescribed. PrEP is much less effective when it isn't taken consistently.

Is PrEP Right for You?

PrEP may benefit you if you test negative for HIV and any of the following apply to you:

• you have had anal or vaginal sex in the past 6 months, and you:
• have a sexual partner with HIV (especially if the partner has an unknown or detectable viral load), or
• have not consistently used a condom, or
• have been diagnosed with an STD in the past 6 months.

Or

• you inject drugs and
• have an injection partner with HIV, or
• share needles, syringes, or other injection equipment.

Or

• you’ve been prescribed PEP (post-exposure prophylaxis) and you
  • report continued risk behavior or
  • have used multiple courses of PEP

You may choose to take PrEP even if the behaviors above don’t apply to you. Talk to your health care provider.

If you have a partner with HIV and are considering getting pregnant, talk to your doctor about PrEP. PrEP may be an option to help protect you and your baby from getting HIV while you try to get pregnant, during pregnancy, or while breastfeeding.

What Drugs Are Approved for PrEP?

PrEP can be pills or shots.

There are two pills approved for daily use as PrEP. They are combinations of two anti-HIV drugs in a single pill:

• Truvada® (emtricitabine/tenofovir disoproxil fumarate) is for all people at risk for HIV through sex or injection drug use. Generic versions are also available.

• Descovy® (emtricitabine/tenofovir alafenamide) is for sexually active men and transgender women at risk of getting HIV. Descovy® is not for people assigned female at birth who are at risk for HIV through receptive vaginal sex.

A long-acting injectable form of PrEP has also been approved by the FDA:

• Apretude® (cabotegravir) is for people at risk for HIV through sex who weigh at least 77 pounds (35 kg). It’s an injection given by your health care provider every other month instead of daily oral pills.

Is PrEP Safe?

PrEP is safe. No significant health effects have been seen in people who are HIV-negative and have taken PrEP for up to 5 years.

Some people taking PrEP may have side effects, like nausea, diarrhea, headache, fatigue, and stomach pain. These side effects are usually not serious and go away over time. If you are taking PrEP, tell your health care provider if you have any side effect that bothers you or that does not go away.

And be aware: PrEP protects you against HIV but not against other sexually transmitted infections (STIs) or other types of infections. Combining PrEP with condoms will reduce your risk of getting other STIs.

How Do You Get PrEP?

If you think PrEP may be right for you, visit your doctor or health care provider. PrEP is only available by prescription. Any health care provider licensed to write prescriptions can prescribe PrEP; specialization in infectious diseases or HIV medicine is not required.

Because PrEP is for people who are HIV-negative, you’ll have to get an HIV test before starting PrEP and you may need to get other tests to make sure it’s safe for you to use PrEP.

If you take daily oral PrEP, you’ll need to see a health care provider every 3 months for repeat HIV tests, prescription refills, and follow-up. If you use injectable PrEP, you’ll need to see a healthcare provider every two months for an HIV test and the injections.

How effective is PrEP?

PrEP is highly effective for preventing HIV.

• PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed.
• Although there is less information about how effective PrEP pills are among people who inject drugs, we know that PrEP pills reduce the risk of getting HIV by at least 74% when taken as prescribed. Currently, PrEP shots are not recommended for people who inject drugs.
• PrEP is less effective when not taken as prescribed.

How long does PrEP take to work?

• For receptive anal sex (bottoming), PrEP pills reach maximum protection from HIV at about 7 days of daily use.
• For receptive vaginal sex and injection drug use, PrEP pills reach maximum protection at about 21 days of daily use.
• No data are available for PrEP pill effectiveness for insertive anal sex (topping) or insertive vaginal sex.
• We don’t know how long it takes for PrEP shots to reach maximum protection during sex.

Is PrEP right for me?

PrEP can help protect you if you don’t have HIV and any of the following apply to you:

You have had anal or vaginal sex in the past 6 months and you

• have a sexual partner with HIV (especially if the partner has an unknown or detectable viral load),
• have not consistently used a condom, or
• have been diagnosed with a sexually transmitted disease in the past 6 months.

You inject drugs and you

• have an injection partner with HIV, or
• share needles, syringes, or other drug injection equipment (for example, cookers).

You have been prescribed PEP (post-exposure prophylaxis) and you

• report continued risk behavior, or
• have used multiple courses of PEP.

You may choose to take PrEP, even if the behaviors listed above don’t apply to you. Talk to your health care provider.

Can I take PrEP during pregnancy or while breastfeeding?

If you have a partner with HIV andare considering getting pregnant, talk to your health care provider about PrEP if you’re not already taking it. PrEP may be an option to help protect you and your baby from getting HIV while you try to get pregnant, during pregnancy, or while breastfeeding.

Can adolescents take PrEP?

Yes. PrEP pills are approved for use by adolescents without HIV who weigh at least 77 pounds (35 kg) and at risk for getting HIV from sex or injection drug use. PrEP shots are approved for adolescents at risk for getting HIV from sex.

How can I start PrEP?

Talk to your health care provider if you think PrEP may be right for you. PrEP can be prescribed by any health care provider who is licensed to write prescriptions.

Before beginning PrEP, you must take an HIV test to make sure you don’t have HIV.

• While taking PrEP, you’ll have to visit your health care provider routinely as recommended for
  • follow-up visits,
  • HIV tests, and
  • prescription refills or shots.
• Ask your health care provider about mail-in HIV tests and telehealth services for follow-up visits.

If you don’t have a health care provider, you can use the HIV prevention services locator to find a PrEP provider near you.

Can I start PrEP or continue taking PrEP without in-person visits to a provider?

With telehealth (phone or video consultation with a health care provider) and mail-in HIV tests, it is possible to order a specimen collection kit which contains the supplies to do the testing required to start or continue taking PrEP pills, even if an in-person appointment is not possible. If you are receiving PrEP shots, you’ll need to visit your health care provider for your shot.

What if I need to stop taking PrEP?

There are several reasons why people stop taking PrEP:

• Your risk of getting HIV becomes low because of changes in your life.
• You don’t want to take a pill as prescribed or often forget to take your pills.
• You can’t visit your health care provider to receive your shots routinely as recommended.
• You have side effects from the medicine that are interfering with your life.
• Blood tests show that your body is reacting to PrEP in unsafe ways.

Talk to your health care provider about other HIV prevention methods that may work better for you.

If I stopped taking PrEP, how do I start taking it again?

Tell your health care provider that you would like to start taking PrEP again. You will need to take an HIV test before you start PrEP to make sure you don’t have HIV.

Can I take PrEP just once, if I think I might have recently been exposed to HIV?

• PrEP is for people who are at ongoing risk for HIV.
• PrEP is not the right choice for people who may have been exposed to HIV in the last 72 hours.
• If you may have been exposed to HIV in the last 72 hours, talk to your health care provider, an emergency room doctor, or an urgent care provider about PEP (post-exposure prophylaxis).

Why do I need to take PrEP as prescribed?

• You must take PrEP as prescribed for it to work.
• If you do not take PrEP as prescribed, there may not be enough medicine in your bloodstream to block the virus.
• The right amount of medicine in your bloodstream can stop HIV from taking hold and spreading in your body.

Can I take PrEP while on birth control?

There are no known interactions between PrEP and hormone-based birth control methods, e.g., the pill, patch, ring, shot, implant, or IUD. It is safe to use both at the same time.

Will PrEP interfere with my hormone therapy?

There are no known drug conflicts between PrEP and hormone therapy, and there is no reason why the drugs cannot be taken at the same time.

Can I stop using condoms if I take PrEP?

• PrEP provides protection from HIV but does not protect against other sexually transmitted diseases (STDs) or prevent pregnancy.
• Condoms can help prevent other STDs that can be transmitted through genital fluids, such as gonorrhea and chlamydia.
• Condoms are less effective at preventing STDs that can be transmitted through sores or cuts on the skin, like human papillomavirus, genital herpes, and syphilis.

If I am not at ongoing risk for getting HIV, can I take PrEP only when I’m at risk?

Taking PrEP pills only when you are at risk for getting HIV is known as “on-demand” PrEP.

• It is also known as “intermittent,” “non-daily,” “event-driven,” or “off-label” PrEP use.
• The type of “on-demand” PrEP that has been studied is the “2-1-1” schedule. This means taking 2 pills 2-24 hours before sex, 1 pill 24 hours after the first dose, and 1 pill 24 hours after the second dose.
• There is scientific evidence that the “2-1-1” schedule provides effective protection for gay and bisexual men* when having anal sex without a condom.
• We don’t know how “on-demand” PrEP works for heterosexual men and women, people who inject drugs, and transgender persons.

Some health departments in the United States and some health organizations in Europe and Canada are offering guidance for “on-demand” PrEP as an alternative to daily PrEP for gay and bisexual men at risk for HIV.

Although the updated PrEP guideline provides information on how to correctly use the “2-1-1” schedule, this approach is not approved by the U.S. Food and Drug Administration (FDA) and is not recommended by CDC. Taking PrEP as prescribed is currently the only FDA-approved schedule for taking PrEP to prevent HIV. When taken as prescribed, PrEP is highly effective for preventing HIV.

Anyone considering PrEP should discuss the issue with their health care provider.

* The term “gay and bisexual men” is used to describe men who identify as gay or bisexual, as well as men who have sex with men who do not identify as gay or bisexual.