Effectiveness of Truvada Medication for PrEP

Over the years, the surest way to prevent HIV (which can become AIDS) has been to avoid unprotected sex and avoid conditions that could put one at risk as much as possible. Basically, PrEP is the use of drugs to prevent HIV-negative individuals from contracting HIV or help HIV patients manage the infection. Now, the question is: is Truvada really effective in preventing HIV?

However, since 2010, that started to change with the announcement of a statistically meaningful result from the first randomized medical experiments of PrEP (pre-exposure prophylaxis) in humans.

The result showed that the rate of HIV infection in non-infected gay men who took the Truvada pills daily was reduced by 44% [1]. Two years after that announcement, Truvada was approved as the only PrEP medication.

When used for prophylaxis (before exposure to the virus), a single pill of Truvada is to be taken every day by people who have tested negative for HIV and want to make sure they keep things that way. For the control and management of HIV (i.e. in infected individuals), Truvada is taken in combination with other drugs.

As much as PrEP may not be a bad idea for everyone, it is only recommended for certain people because it requires a commitment to take the drug every day and to see the doctor at least once every three months. Not everybody will be able to do this. Therefore, PrEP is recommended for individuals who are currently HIV negative but face a serious risk of getting the virus from sex or sharp objects. Examples of such people include:

• people with ongoing sexual relationships with HIV positive partners;
• heterosexual women or men who do not use a condom regularly during sexual activity;
• gay or bisexual men;
• drug users who inject themselves.

Nevertheless, anyone who does not belong to any of these categories may still be cleared to take PrEP. This is provided they will be consistent with it.

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🔍Does Truvada Really Work?

Studies have revealed that the anti-HIV strategy helps reduce the risk associated with contracting HIV from sex by over 90%. For drug users who inject themselves, pre-exposure prophylaxis reduces HIV risk by over 70% [2].

However, before talking about whether or not Truvada works for HIV PrEP, it’s best to first understand how HIV operates in the body.

Whenever a cell gets infected by HIV, it loses its normal function, as the virus takes total control of it. Afterward, HIV forces the cell to make multiple copies of the virus. And to do this, the cells utilize proteins known as reverse transcriptase. This is where Truvada comes in.

Truvada is made up of two main ingredients:

• FTC – belongs to a drug group known as nucleoside analogs (“nukes”);
• tenofovir DF – belongs to a drug group known as nucleotide analogs (“nukes”).

These two medicines in Truvada affect the enzyme “reverse transcriptase.” HIV-infected cells use this enzyme to make copies of the virus. As a result, HIV-infected cells are slowed down or stopped from replicating and spreading further. So yes, Truvada really works. However, it is important to note that the medication is not meant to replace other protective measures such as the use of condoms and regular tests – it is meant to be used along with them.

📝Factors That Have Influence on Truvada Effectiveness?

While it is an established fact that Truvada effectively protects HIV non-infectees from contracting HIV, its effectiveness can be influenced. Truvada effectiveness can be affected by the absence or presence of certain factors. These factors were ascertained through an assessment of randomized intervention trials.

If these factors are taken into consideration while on PrEP, users can enjoy the full effectiveness of the medication, i.e. reducing their risk of contracting HIV/getting the viral infection by the stipulated 92% – 99%.

Some of the factors which have an influence on the effectiveness of Truvada include:

📅Feature of Medical Adherence

Medical adherence remains a major factor that influences PrEP effectiveness. It is not enough to take the drug; it has to be taken daily at just about the same time every single day. The patterns in which pills are taken have a major impact on the level of protection that will be provided. According to the World Health Organization (WHO), to be effective, the treatment requires a high rate of adherence [3].

At this point, it’s important to know what influences adherence in people who begin the treatment. Some of the factors that affect adherence among current users of the prophylaxis strategy include [4]:

• forgetfulness: 41.5% said they needed help to remember to take their drugs;
• high cost: on average, without insurance, a participant spends about $1300 monthly on PrEP. While 50.9% of PrEP users received financial support to fund their treatment, 24.5% have further indicated that they need help to pay for PrEP.

In other research known as bivariate analysis, the following were found to be other factors that affect adherence in PrEP users:

• color of the pill;
• size of the pill;
• having to report sexual activities without condom use in the 4-week period before measurement;
• use of oral contraceptive pills (OCP) at enrollment.

All these notwithstanding, Truvada has to be used regularly and consistently for best results. Refusal to do this will affect the performance of the drug.

💊Recreational Drugs

These are drugs, both legal and illegal, that are used without a prescription or medical supervision. As the name implies, recreational drugs suggest drugs that are fun and safe, so they could be taken whenever and however.

Recreational drugs can be divided into four categories:

1. Analgesics: they include narcotics such as codeine, morphine, heroin, and fentanyl.
2. Depressants: they include barbiturates, nicotine, tranquilizers, and alcohol.
3. Stimulants: they include methamphetamine, ecstasy, and cocaine.
4. Hallucinogens: they include magic mushrooms, LSD (acid), peyote (mescaline), phencyclidine (PCP), ketamine, marijuana, and salvia divinorum (diviner’s sage).

The four listed categories of recreational drugs interact with most other prescribed drugs, and Truvada is not an exception. However, this is not always the case. The risk is even higher at the early stage of PrEP as the body is getting used to processing the drugs, so adding a recreational drug at this time poses a higher risk of causing a complication.

Users of Truvada who depend greatly on recreational drugs are advised to inform their healthcare provider or doctor in order to be properly informed.

🍏Food & 🥃Alcohol

It’s okay to take Truvada with or without food. Furthermore, there are no certain or specific types of food that need to be taken alongside it. The pills can be taken with a snack or about 30 minutes after a heavy meal is eaten, or on an empty stomach.

Studies show that Truvada offers the same effectiveness when taken with food as it does when taken without it. In general, recommendations based on whether or not to take this drug with or without food may vary from place to place. For example, in the USA, recommendations indicate that the pill can be taken with or without food while in Europe, it is recommended to take it with a meal.

Regarding taking Truvada with alcohol: generally, Truvada does not interact with alcohol, and one or two glasses will be fine. However, when taken in excess quantity (due to intoxication), one may skip doses of the drug.

What’s more, while alcohol does not interact with the drug, it might increase the risks or worsen potential side effects. For example, taking alcohol alongside the pill could cause or magnify a feeling of dizziness.

Also, excessive consumption of alcohol while medicating with Truvada might increase the risk of kidney or liver problems.

Therefore, anyone taking Truvada should eschew alcohol or meet with a healthcare provider or doctor for a discussion so as to know the risks involved.

🤔Another Tablet?

Truvada medication is known to interact with about 250 other drugs, and as such, care should be taken if the need to co-administer arises.

This drug should not be taken alongside other drugs that can affect the kidney. Doing this could lead to the damage of the kidneys. It also poses a risk of increasing the levels of the drug in the body which increases the risk of side effects [5].

Some drugs Truvada interact with include:

• aspirin;
• cidofovir;
• adefovir (Hepsera);
• gentamicin;
• ganciclovir (Cytovene);
• acyclovir (Zovirax);
• diclofenac (Cambia, Voltaren, Zorvolex);
• valacyclovir (Valtrex);
• valganciclovir (Valcyte);
• naproxen (Aleve);
• ibuprofen (Motrin).

In other words, the above-listed drugs should be completely avoided when taking Truvada. Nevertheless, different interactions can lead to very varying effects. While some affect how well the drug works, others can increase side effects. Therefore, before following the PrEP strategy (taking Truvada), be sure to inform a healthcare provider or a doctor of all prescriptions and other drugs you take. Also, let them know about any herbs, vitamins, and supplements you take. This will guide the doctor and help you avoid potentially dangerous interactions.

⏱How Long Does It Take for Truvada to Be Effective?

Findings have shown that a high level of PrEP efficacy and rectal tissue concentrations can be reached in HIV uninfected men who engage in sexual intercourse with other men (MSM) after about a single week of daily dosing. This high level of protection can go on to last for several days after the last dose.

However, the US CDC (Centers for Disease Control) stated in a guideline of clinical practice on PrEP that scientists do not have an answer yet on the time it takes PrEP to be fully effective after the first dose. It added, however, that some studies suggest that if taken every day, Truvada reaches its maximum level of protection in blood at 20 days, about 7 days in rectal tissue and about 20 days in vaginal tissue [6].

🎈Should I Use Condoms During Truvada Intake?

The promise by Truvada to prevent the contraction of HIV seems to be leading heterosexual women and men towards using Truvada as a substitute for a condom, especially within the context of commercial sex. There are a number of problems with this.

To start with, while condoms provide adequate protection against varying sexually transmitted diseases, Truvada only protects against HIV. So, refusal to use condoms risks exposure to other STDs such as chlamydia, syphilis, and gonorrhea. While some of these infections are curable, there are times that some can be resistant to antibiotics. For instance, drug-resistant gonorrhea is still a major public health concern.

Truvada will always be a valuable tool in HIV prevention, especially among groups with high risk like transgender women and men who have sexual intercourse with men. Nevertheless, serious care must be taken to prevent seeing Truvada as a substitute for condoms use.

📜Takeaway

In conclusion, Truvada for prophylaxis provides between 92% to 99% risk reduction for people who have tested negative for HIV and who take the pills in accordance with the prescription – every day. Missing a dose may decrease the level of HIV protection.

Also, Truvada is meant to be used with condoms, not as a substitute.

Adequate data are not available on the specific timing guidance on daily use, so the FDA’s recommendation remains that the prophylaxis protocol is followed every day to attain an optimum level of protection. Other things to note include:

• when starting to use Truvada, it takes about seven days to attain high levels of protection against the human immunodeficiency virus (HIV);
• when Truvada use is to be stopped, individuals should continue using it for at least 28 days counting from the day of the last significant exposure;
• Truvada provides no protection against other STDs besides HIV, nor does it prevent pregnancy.

Finally, the need to consult a healthcare provider or doctor before starting the use of Truvada cannot be overemphasized. A healthcare provider or doctor will provide guidelines especially with regards to interaction with other drugs, legal and illegal, and food.

Interested in getting Truvada or its generic versions for PrEP? The pills can be obtained in certain pharmacies without a doctor’s prescription, or online without the need for it. If you want to know more about Truvada medication, our website HIVPrEP has already prepared more articles for you.

📚References

1. Pre-Exposure Prophylaxis for HIV Prevention: Safety Concerns. Raymond A. Tetteh, Barbara A. Yankey, Edmund T. Nartey, Margaret Lartey, Hubert G. M. Leufkens, Alexander N. O. Dodoo. Drug Safety. April 2017, Volume 40, Issue 4, pp 273–283.
2. Pre-exposure prophylaxis. HIV.gov. Revised on May 28, 2019.
3. WHO consultation on PrEP adherence: meeting report, June 2014. WHO/HIV/2014.43.
4. PrEP Uptake, Adherence, and Discontinuation Among California YMSM Using Geosocial Networking Applications. Ian Holloway, Ryan Dougherty, Jennifer Gildner, Sean Beougher, Craig Pulsipher, Jorge Montoya, Aaron Plant, Arleen Leibowitz. JAIDS Journal of Acquired Immune Deficiency Syndromes. 74(1):15–20, January 2017.
5. Drug information on Truvada tablet. AIDSinfo. September 19, 2018.
6. Basic questions and answers on HIV pre-exposure prophylaxis. cdc.gov. Revised May 28, 2019.