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Episode 8 Transcript

PrEP vs. PEP for HIV Prevention

Erin Everett:

Hey everybody, and thanks for listening into Exclusively Inclusive. I’m your host, Erin Everett. And today I wanted to talk to you about the difference between PrEP and PEP. I get a lot of questions about it both pertaining to HIV prevention. I, so I wanted to clear up some of the misinformation out there and just give listeners a really good useful guide on navigating the two different PrEP and PEP treatments.

What is PrEP?

So first let’s start with PrEP. What is PrEP? PrEP stands for preexposure prophylaxis. Now when we’re talking about exposure, we mean exposure to HIV.

So PrEP is a treatment that we use to prevent someone from getting HIV before they’ve even been exposed to it. And that’s really important to know because that’s the main difference between PrEP and PEP. Now we actually have the option for two different medicines for PrEP. One is Truvada and the other Descovy and we’re going to have a whole segment on the differences between those medications but today I’m just going to introduce those medications very briefly as an option for PrEP.

PrEP Medications: Truvada & Descovy

So Truvada has been prescribed for PrEP since about 2012 when it was first approved. And is manufactured by Gilead, Gilead manufactures both Truvada and Descovy and both of them a one tablet once a day. They both have great efficacy rates. They have been shown to be effective at preventing HIV. Up to 98% of the time when taken daily. There are alternative ways to take Truvada. However at practice we don’t really subscribe to that fully because the CDC has not jumped on board with on demand PrEP yet. So what we’ll just be talking about is daily PrEP. So when Truvada is taken every day, it’s extremely effective against preventing HIV. You do have to take it every day in order for it to work up to that 98%.

PrEP Side Effects

Now, the most common side effects of taking Truvada would be a little bit of increase in bowel movements, some GI upset, headaches, dry mouth.

Those all tend to disappear within the first two to four weeks. If they persist longer than that, then we definitely have that conversation with patients and decide whether or not we need to go ahead and try Descovy, which they both very similar to the side effect. Profiles are similar, but I have had patients experience negative side effects with one and not the other. So we do talk about that or we talk about discontinuation altogether. But again, that takes a novel conversation about risk versus benefit before we can even land at that point.

Who Should Be on PrEP for HIV Prevention?

People often ask me, who is a good candidate for PrEP? Who should consider taking it? Well, when we talk about who should consider taking PrEP, I lean heavily on the CDC and the IAS guidelines. And the IAS guidelines is the International Antiviral Society that also post guidelines for this. But of course the CDC, everybody knows about the CDC, so you can actually go to a cdc.gov/hiv/basics/PrEP. And they’ll actually have all of the things that we’re talking about today summarized nicely as a good resource. But one of the things they do post is who should consider taking PrEP?

Receptive Penetrative Intercourse

Well, anybody who’s engaging in any type of anal or vaginal sex, especially receptive. That means if you’re the one getting penetrated. That is one of the highest risk sexual behaviors when it pertains to a contracting HIV. Mostly because HIV is a very fragile virus. It doesn’t live outside the body or in contact with oxygen for very long.

So when you have it and it’s ejaculated into a vagina and anal canal, it’s protected from the environment. And also both of those areas have a lot of veins. So we say it’s very vascular. So if there’s any kind of tissue trauma from penetration and insertion, which you know even there is, even if you don’t feel that the tissues are being disrupted, it’s an opportunity for HIV to enter through those little veins. So that’s why it’s considered one of the most highest risk sexual behaviors when it comes to HIV transmission. So anyone in the past six months that has had receptive anal or vaginal sex, especially if you know that your sexual partner has HIV and you’re not sure what their viral load is. If the viral load is undetectable, you’re considered untransmittable. So if you have a longterm partner who is HIV positive and stays on the medication and is undetectable, you can get on PrEP if it makes you feel mentally at ease. But technically there’s no medical reason to get on it because that person is not able to give you HIV.

So if any of those apply to you or if you have inconsistent condom use. Some people, for whatever reason, there’s multiple reasons why people went on have consistent condom use. Or if you’ve been diagnosed with an STD or an STI infection in the last six months. Because if you’ve able to engage in behaviors that allowed you to get an STI or STD infection, then you put a potentially put yourself at risk for getting HIV.

Intravenous Drug Use

PrEP is also recommended for people who inject IV drugs or share needles, whether it’s for drug use or whatever. Because again, just like with that receptive sex, the bevel or the tip of a needle protects the HIV virus in the blood. So if someone has HIV or hepatitis, but we’re just talking about HIV today ,and they insert the needle in their vein to inject drugs, when they pull it out, there’s still going to be a little bit of blood patch in that needle from their blood. And then you take the needle and inject yourself. You’re putting their protected blood that is infected with HIV directly into your vein. And we’re saying if you don’t know whoever you’re sharing needles with, if they’re HIV positive or negative, then it’s super important for you to be on PrEP. I mean it’s also really important that you don’t share needles, but if you know that you’re having an issue with that and then getting on HIV prevention is definitely a good option for you.

Multiple Sexual Partners

So anybody who has more than one sexual partner, engages in sexual activities for work or is just having more frequent types of sex and high risk sex. All of those people would be good candidates for PrEP. And so it’s really important to be having an open, honest discussion with your provider. Because if you’re someone who fits into any of the categories described, then PrEP is available to you and has great commercial coverage. And we even have a lot of resources now for those who are uninsured or under insured so that they can also obtain PrEP. Gilead has actually launched a program where a certain number of people are going to be able to get a Truvada for free if their insurance isn’t covering it or they don’t have insurance coverage at all. Just as one of their measures to help contribute to the efforts to reduce HIV risk in HIV transmission.

PrEP Administration & Efficacy

So as I touched on before, how well does PrEP work? Well, PrEP works really well. When you take PrEP every single day. Like I said, the studies have shown 98% to 99% effective. CDC reports 99% and that is for sexual practices. However, that does drop when you’re talking about injecting IV drugs. You know the CDC reports a 74% efficacy rate. That means 74% of the time you’ll be protected against HIV when injecting and sharing IV needles while you’re on Truvada for PrEP or Descovy. Because they both have very similar efficacy rates. And the data in the head to head trials was so solid that one of the studies that they did, nobody in the Descovy arm even contracted HIV.

So they’re just as effective as each other. But it is important to note that even if you’re on Truvada for PrEP, there’s still a risk of HIV. While the risk is lowered, there is still risk. So I kind of tell my patients, it’s like wearing your seat belt even though you have airbags, you still have to take other measures to protect yourself. It also does not protect against any other STI or STD infection. So you’re still at risk for syphilis, gonorrhea, chlamydia, mycoplasma, genitalium, ureaplasma, hepatitis A, B or C. Lots of different viral infections and bacterial infections. So it’s really important to still use a barrier method of protection when at all possible.

How Long Do You Have to Take PrEP for HIV Prevention?

So how long would someone really need to take PrEP for? Well, people need to take PrEP to prevent HIV as long as they remain at higher risk for contracting HIV. So if you have circumstances in your life that changed, that reduce your risks, perhaps you have decided to be celibate and not have sexual intercourse with anybody for some period of time. Then coming off PrEP seems like a suitable option for you. If you decided to be in a monogamous relationship and you know whether or not your partners are living with HIV or not, and if you’re adherent to the medications you may decide to stop.

There’s lots of different reasons why someone might decide to come off of Truvada and having that conversation with your healthcare provider is really important so that you’re making a good educated, solid decision on whether or not discontinuing Truvada is right for you. So as it pertains to side effects, if someone was having a lot of significant side effects, even while they remained at higher risk for HIV, they may decide to discontinue it based on the severity of the side effects. But again, I always recommend that people talk to their healthcare provider and make those decisions together.

Need for Backup Contraceptives When First Starting PrEP

When people first start taking PrEP, we typically recommend that they use an alternative form or a backup form of contraceptive and STI prevention like a condom, dental dams, things like that. For the at least the first seven days, if they’re engaging in anal sex. We said it usually takes about seven days for it to become fully effective. Now that does vary if you’re having vaginal intercourse because for some reason the data has shown that the serum levels of Truvada tend to be lower in the vaginal tissue, so we recommend 21 days then have continued daily dosing to get the full benefit from Truvada for PrEP. Now some of this is going to vary for Descovy and again, we’re going to have a whole segment where we talk about the differences between Truvada versus Descovy but it is important to know that Descovy is not approved for cisgendered women.

Descovy is NOT Approved for Cisgendered Women

It is not approved for cisgendered women. They just were not include it in this study and therefore the company cannot speak to its efficacy on cisgendered women. So far, Descovy’s only approved for men who have sex with men and transgender women. So basically anybody with a biological penis or who’s engaging in anal sex or penetrative vaginal sex. So that’s really important to note because if you know you’re sitting there as a cisgender female listening, wondering if you can switch from Truvada to Descovy. No you cannot right now. They are working on the studies and hopefully it will get approved in the coming years. But right now it is not approved and it’s very important that you know that.

Risks & Side Effects of Truvada PrEP

And part of the buzz with people asking about that is about the longterm negative side effects of Truvada. There’s been a little hype in the media about it so I just want to talk about that a little bit.

Kidney Function

People are concerned about the renal function with Truvada. So over longterm use Truvada can cause a slight decrease in renal function. And what we have noticed though is that when people come off the medication, it returns to normal. And it doesn’t actually seem to be impacting their renal function. But rather the numbers that we measure, like the creatine clearance level and the glomerular filtration rate may change a little bit. And for lay people or people who had not medical providers are in the medical field. Those are just two numbers we look at to see how well your kidneys are working. And so sometimes those numbers go up a little bit, but actually it’s not having anything to do with how well your kidneys are working. But if you are on Truvada for PrEP, you should be following up with your provider every three months for blood work.

And the importance of that is to maintain an HIV negative status because if for some reason you have seroconverted to HIV, Truvada is not a complete regimen for HIV treatment. And therefore it’s important so we can add more medications to your regimen and treat your HIV properly. And the other is to check kidney function. So of all the years that I’ve been prescribing PrEP, I haven’t had to take people off of it because their kidney function, unless something else was going on. But it wasn’t solely due to the Truvada.

Bone Mineral Density

The other thing that people talk about is bone mineral density. The way that Truvada is metabolized in the body and works to prevent HIV from getting into the cell is by taking a little bit of calcium out and when it takes the calcium out it makes it less available for your bones.

And so longterm there has been some data to show that there could be a decrease in bone mineral density. Most of the studies have been conducted on people living with HIV. And so there’s other things going on that contribute to that decrease in bone mineral density. And the studies that we do have for people who are not living with HIV and it just taking it for prevention. A majority of the population were biological or cis males who have sex with men and around the ages of like 25 to 35. There was definitely some stragglers outside of that age wise, but that was the majority of the age.

And we did see that when we discontinued the Truvada that the bone mineral density did return to normal. However, we can’t speak to the older population because we didn’t have the data available. So in those circumstances that might be suitable to talk about switching over to Descovy that does not have the renal and bone side effects. But again, that’s a conversation that you need to have with your healthcare provider because you know there’s other factors that play into that decision. Like other diagnoses you may have. Whether it’s diabetes, high cholesterol, high blood pressure, all these things are things to be considered when you’re taking any medication, but particularly Truvada for PrEP. And so to having that conversation with your provider, you’ll be able to determine what one is best for you and a suitable timeframe for you to take it. And when we need to consider switching based on your health history.

Need for Regular Followup Appointments While on PrEP

So we’ve kind of talked about who is a good candidate for PrEP, what is PrEP and some of the side effects and how long do I need to be on it and how long will it take for it to start working. But what we haven’t covered is what should a PrEP followup look like and why do I have to come back every three months? Well, a PrEP followup should be pretty simple. You’re going to meet with your provider every three months. And the reason for that is, and I touched on it briefly earlier, is we said that the efficacy rates for PrEP are 98% to 99% so that means still 1% to 2% of the population will contract HIV while taking Truvada for PrEP. And so it’s really important that we catch those new infections because Truvada is not a complete HIV regimen. And so if you do a what we call seroconvert or contract HIV while you’re taking PrEP, then we can add medications to make sure you’re in a complete regimen and have the best possible outcome.

So that’s one of the reasons. Why the other reasons why is check kidney function. We touched on that to make sure your kidneys are still healthy. And then also to to offer any additional STI screenings. Because if you’re engaging in behaviors that could have you contract HIV, you could also be contracting other STI infections like syphilis, chlamydia, gonorrhea, mycoplasma genitalium, herpes, those types of things. And so offering up testing and treatment for those different infections is extremely important. Currently, right now in Atlanta, we have huge rates of syphilis and gonorrhea in particular, and so whenever my patients come in, I talk to them about what we call three site testing.

So that also should be a part of your visit and if it’s not being offered as a part of your visit, then it’s something that you need to bring up to your healthcare provider. Because three site testing allows us to test for gonorrhea and chlamydia in the back of the throat, in the rectal tissue or the vaginal tissue or sometimes both if you’re using both organs. And that’s what we need to test for. And then also the urethral tract. So we usually have patients, if it’s a men who have sex with men, we usually have them leave a urine sample. We’ll do a rectal swab and a throat swab. For anybody with a vagina. We offer up a vaginal swab, rectal swab, urine sample, depending on their habits and a throat swab.

So sometimes we can capture enough of a sample from just doing a vaginal or a urine sample, but it just depends on the person and what they’re engaging in. And so it’s really important to do a thorough sexual health screening with your patients. So you know… And also to be honest with your provider so your provider knows where they should be testing you. And then through the blood we also add on syphilis.

You know a lot of providers don’t routinely test for herpes anymore. There are some certain situations where it would be good if you know that your partner is positive for herpes and you don’t know if you are not. Going ahead and getting that blood test could relieve some conversations about whether or not you’re at risk of getting herpes from them. Because if you already have it, then no, there’s no risk. Or you know, somebody comes in with sores or lesions. We definitely send off a viral culture to determine what those are. So that we can treat accordingly. So that’s really important that those components of being part of your PrEP follow up. The majority of gonorrhea and chlamydia is asymptomatic when it’s found in the throat and rectal tissues. So that’s why we offer a routine screenings for it. And the majority of cases that I find are found on routine screenings and patients are often shocked.

They’re like, “What, how long have I had that? I didn’t know.” You know, and if they’re new to me, I don’t know how long they had it. If I they come and see me every three months I can either say, “Well you didn’t have it three months ago. So somewhere in between there.” And you know there are anonymous ways to alert your sexual partners to your new STI infections and you can usually do that through your health department. So if you don’t feel comfortable calling your partner and letting them know about your positive test results, there is other ways that we can attack that for you.

Cost of PrEP HIV Prevention Drugs

Another thing that people ask a lot about is how much does PrEP costs? And like I mentioned before, it’s very well covered commercially.

Commercial Insurance Coverage for PrEP

Truvada has more coverage than Descovy right now, but a lot of plans are paying for Descovy. And what happens is it gets billed to your commercial plan and if there’s a lot of money left over or any type of co-insurance leftover, and that was really going to depend on the way your plan is set up. Some people won’t have a copay on it regardless. Some people it’s going to hit their entire deductible. So they’re going to get a nasty bill from the pharmacist and sticker shock.

Gilead Advancing Access Program

So when that happens, we direct people to the Gilead advancing access program. If your healthcare doesn’t provide you with the Gilead copay card at the time of your visit, then this is something that you can go to and access online gileadadvancingaccess.com. And it’s a simple application and what that does is allows money to go towards your coverage of PrEP.

So if you get to the pharmacy and they bill your insurance and they say you have $1,200 leftover, while this program covers up to $7,200 in copays per year with no monthly limit. So that means that when they tell you it’s $1,200 the rest gets taken off that Gilead copay card. And there’s 7,200 left. But that’s not like you’re going to have to pay $1,200 every month because once your deductible and your out of pocket expenses are met, then you don’t need the card anymore. And so if you run out of money on the card, but your benefit has been met, it should still continue to be free. And I hope that makes sense because navigating health insurance can be really challenging. But basically when you go to the pharmacy, you need to make sure that the pharmacist bills your insurance first and whatever copays or co-insurance is a leftover. That’s where the Gilead card kicks in and it has up to $7,200 just for those two drugs.

So whether you’re on Descovy or Truvada, you’ll have money to contribute towards your healthcare costs. Now of course the conversation changes a little bit when patients don’t have commercial insurance. And depending on your geographical location, there’s going to be resources for you in your area. And we’ll post some resources on our ExclusivelyInclusivepodcast.com website for people local or close to Atlanta. But a lot of health departments are offering PrEP clinics where it’s like free or to reduce costs. A Gilead also has resources on their website where you can get PrEP free or to reduce cost. And so there are ways to access it. But thank you to the Affordable Healthcare Act. No commercial insurance can deny coverage for Truvada anymore for PrEP. Now that’s different for Descovy because it’s a newer drug and it’s a little bit more expensive but they do at least have to cover Truvada.

So that is awesome. Especially when we talk about, obviously we want to reduce the risk of transmission and HIV on a personal front. Like I don’t want my patients contracting a virus that was preventable. But also when we look at globally and just geographically reducing the risk and the rates of HIV transmission, having that good commercial coverage here in the United States is huge. It’s really going to help.

So if you have any more additional questions about PrEP or there’s something that you need more detail on or it’s something that you feel like I didn’t cover, please feel free to email me erin@exclusivelyinclusivepodcast.com.

What is PEP?

So we’ve talked about how you prevent HIV if you have not yet been exposed. But what if you have been exposed? Well there is treatment for that as well. And we call that PEP, which is post exposure prophylaxis. So again, the difference is one you have been exposed to HIV, the other you have not.

PEP 72-Hour Window for Efficacy

So when you have been exposed the treatment is post-exposure prophylaxis and you have a 72 hour window from the time of exposure to the time of being able to get on treatment and have it work. If you’re outside of that window, then it’s a different conversation that you have with your provider. It’s more about HIV testing and treatment and followup testing. But if we’re in that 72 hour window, then we can place you on post-exposure prophylaxis and drastically reduce your risk of HIV transmission.

What Medications are Used for PEP HIV Prevention?

So PEP is a combination of drugs. One more talking about PrEP, we talked about Truvada. Truvada is also a component or can be a component of post-exposure prophylaxis. But it’s more than that. We also added an another HIV drug and depending on the patient and their insurance coverage and what not, we have other options that most of the time in my practice I’m prescribing either Truvada and Descovy with dolutegravir and dolutegravir is an integrase inhibitor. And it’s great for HIV treatment. And when they’re dosed together you can reduce your risk of contracting HIV by more than 80%. That’s huge. So if you have been exposed to HIV and you go to a provider or an urgent care clinic or the ER where they’re prescribing post-exposure prophylaxis and you get on these treatments within 72 hours of your encounter, then we’ve lowered your risk of HIV transmission by more than 80%. And those numbers are published by the CDC. So we do have data to back that up.

PEP Medication Administration

The safety and tolerability of the post-exposure prophylaxis is very similar to PrEP. However, patients may have a little bit more side effects just because it’s an additional drug. So, but overall dolutegravir is very well tolerated. One of the other popular integrase inhibitors, which is again the drug class that it’s in that’s often prescribed for post-exposure is raltegravir. And the main reason why I choose dolutegravir over raltegravir is the ease of administration. Raltegravir is often prescribed in twice a day dosing or it’s two tablets once a day, but it’s still for the post-exposure guidelines the twice a day dosing is endorsed.

And so I just feel like for my patients it’s a little bit harder to remember that second dose. So dolutegravir is dosed once a day so patients can literally wake up in the morning or before they go to bed whenever it makes sense and take their Truvada with their dolutegravir and be covered for the day. PEP is considered a 28 day course, so for 28 days you’re going to be taking this medication to reduce your risk of transmission. At the end of the 28 days. We also need to do repeat testing, so we’re going to cover all of that.

What to do if You Think You’ve Been Exposed to HIV

Okay. Let’s start with you’ve been exposed to HIV and now what? You already have a healthcare provider that you know that prescribes post exposure prophylaxis or PEP and so you’re already in the the office visit with them. What’s going to happen for you? Well basically what the healthcare providers going to do is a brief interview to find out what your risk of transmission was, the timeframe in which it occurred, and then we’re going to do some testing and education on the medicine.

So one thing that’s really important to test for of course is HIV, but all the other STIs. So we’re also going to be testing for hepatitis A, B, and C. We’re going to be testing for syphilis, gonorrhea, chlamydia, and then HIV as well. Again, we don’t really have to test for the herpes side of things because it’s less important at this point. But if people were concerned about it, we could add it on. But most importantly we’re doing hepatitis A, B, and C, syphilis, gonorrhea, and chlamydia. And of course if you’re a cis female or anybody who’s at risk for actually having a pregnancy, we want to take a pregnancy test. Now, the other things that we test for that aren’t infectious diseases are your kidney function and your liver enzymes, because all of our medications that we take in some way, shape or form are excreted by the kidneys and liver. And so we need to make sure that those are also healthy.

Followup Appointments While on PEP

HIV Testing

After you’ve taken the PEP for the next 28 days, you’re going to have another appointment with your provider. At which point we would do repeat HIV testing. And this is really important because if you are literally exposed on that encounter and you were negative 28 days later, if the medication worked, you should still be negative. The newer HIV testing can detect the P24 antigen, which can test positive for HIV as early as 15 days after an exposure. So ideally you’re at the 28 day mark that’s that four to six week mark. You’re going to be testing for that again, to ensure it’s still negative.

STI/STD Testing

And then also you’re going to do some repeat syphilis and gonorrhea and pregnancy tests if applicable. And then plan on following up in three and six months for more HIV testing. Which if you’ve gone on PEP for post exposure prophylaxis and you’re my patient, I’m probably starting you on prevention and so you’re going to be following up every three regardless. And so this won’t be unusual for you.

Cost of PEP HIV Prevention

Commercial Insurance Coverage

So as far as insurance coverage goes, it’s very similar to a PrEP. You know, commercial insurance covers it very well and it’s just for the 28 days. And then for a lot of patients, again we’ll be transitioning them to the prevention.

Gilead Advancing Access

The same Gilead copay card applies as it does for PrEP. And so most patients are going to get it free or very cheap. It is important though that you connect your patients with a pharmacy that is familiar with post-exposure prophylaxis so that the pharmacist knows the urgency behind obtaining these meds so that if they’ve run into any issues with insurance coverage or copays or any kind of hassle or they realize that they don’t have one of the components of the regimen in stock, that they immediately find out where they can get it. Because once you’ve been exposed, the clock is ticking because after we reached that 72 hour mark, the regimen is considered ineffective. So it’s really important the sooner you get started on post-exposure prophylaxis, the better and that’s when you’re going to have the best outcome as far as preventing HIV transmission.

If You’re at Risk, You Should Be Treated

You know, getting exposed to HIV can be a scary time and you know, a lot of people don’t know enough about HIV to know what their actual true risk is. So often I do have a lot of people coming to me wanting post-exposure prophylaxis for oral sex encounters or kissing. And those really aren’t necessary. But at the end of the day, if somebody is truly concerned about contracting HIV, I’m going to prescribe post-exposure prophylaxis unless of course I think it will cause more harm. But they’re going to leave with a post exposure prophylaxis regimen because sometimes people will have an intense fear about contracting HIV and and only tell me a piece of the story.

So if someone it’s really good for people to be honest with their providers, but it’s also good for providers to know that if someone has an intense fear of contracting HIV and they’re telling you that they think they might have been exposed to it and you’re doing their risk evaluation and you’re not sure that the risk is really there but they don’t seem any more at ease. I would go ahead and prescribe it unless of course it was contraindicated with one of their other disease processes because it’s always risk versus benefit and there’s not a whole lot of risk when taking these medications if you have not been exposed.

PEP Side Effects

Again, you might experience some of the more benign side effects like GI side effects, headaches, changes in sleep patterns. But they tend to dissipate within the first few days and usually by at least two weeks and the regimen is only 28 days. So even if someone was having mild side effects, they’re still going to want to take it if they felt like their risk for HIV exposure was great. So if you have any additional questions or anything about that, please feel free to email me erin@exclusivelyinclusivepodcasts.com. And I’ll be happy to help you out with any of that.

You know there is actually a Journal for Nurse Practitioners that I receive and I’ve referenced this before in other podcasts, but it actually for any providers out there listening or people in the health care field, it actually has a great writeup on post-exposure prophylaxis and how to administer it, how to evaluate for it, what kind of access a patients have to the costs involved and just how to counsel the patient often.

And a lot of the times once you have met with the patient and that 72 hour window, you can do a lot of reassurance because again, you’re lowering the risk 80%. I haven’t personally had anybody go onto seroconvert HIV positive who came in and you know fit the bill. It’s just been less than 72 hours. We got them started on treatment right away. So it’s extremely effective and so you can feel confident in the reassurance factor there with your patients. But I suggest you give it a read in the Journal for Nurse Practitioners. It was the November issue from this year in 2019 and it has a wonderful writeup. It even goes over all the drugs in the side effects. It also has all the CDC facts and data and alternatives to use. If your patient does have a renal insufficiency, which I’m not going to cover that for my listeners because most people can take the traditional Truvada and dolutegravir regimen and I just don’t want to complicate things with some outdated medicines.

Reach Out for More Information on PrEP vs PEP

So again, if anybody has any questions, please feel free to reach out. It’s so important that if you are a candidate for PrEP, that you get on it before you have to have that conversation with your provider about PEP. You know, having that open conversation and reducing your risk factors for not just HIV but other STIs is so important. And let’s face it, you deserve it. You deserve to be able to have a healthy sex life and engage in sexual practices that make you feel good in a safe environment without judgment.

Okay, everybody, thanks for tuning in and until next time, remember to stay fierce and live your truth.