Short-Term HIV Prevention a Viable Option

By Alan Mozes
HealthDay Reporter

THURSDAY, Aug. 27, 2020 (HealthDay News)

The daily use of antiretroviral meds to help prevent HIV infection has been around for a few years now — it’s called pre-exposure prophylaxis, or PrEP.

PrEP includes combo drugs such as Truvada (tenofovir/emtricitabine). Taken daily, the regimen can reduce the risk of infection to near zero in sexually active people.

Of course, many people balk at taking a pill every day, especially if they know they aren’t going to engage in sex anytime soon. But new research is pointing to a middle way: So-called “vacation PrEP,” where users take the regimen short-term, such as around a vacation.

That’s what Anthony, a gay 42-year-old paralegal in Medford, Mass., did. He’d first taken PrEP daily for nearly a year.

“But I really don’t want to take a medication every day if I don’t need to, because it’s a strong drug and I am a little worried about the side effects,” Anthony said.

He also told his doctor that he “wasn’t having regular sex, but it was pretty easy for me to know when I would be.”

So, his physician offered up vacation PrEP as a viable option.

“In that case I could just take it ‘on demand,'” Anthony explained.

Slashing infection risk

The short-term use of PrEP might help spur uptake more generally — and that could prevent the spread of HIV, experts believe. Higher use of PrEP is sorely needed. Data from one study conducted by the U.S. Centers for Disease Control and Prevention found that, as of 2017, only about one-third of gay and bisexual Americans were taking the regimen.

Though not a vaccine, PrEP is “kind of like a condom for your cells,” said James Egan, lead author of a new study into the use of short-term PrEP. He’s assistant professor at the University of Pittsburgh’s Graduate School for Public Health.

According to the CDC, PrEP cuts the risk of contracting HIV during sex by 99% and by at least 74% among injection drug users — if taken every day.

Most insurers (including Medicaid) cover the cost of the medications and, according to the CDC, side effects are usually mild and short-lived.

In the new study, Egan and colleagues wanted to determine if more gay men might embrace PrEP if they first took it in the “vacation” context.

The trial focused on 48 adult men from Boston or Pittsburgh. All received tutorials on how to use PrEP in a vacation context. That meant beginning a daily regimen one week before going on vacation, taking it while on vacation, and continuing the regimen for at least a week after returning home.

Blood tests taken post-vacation found that most of the men (nearly 94%) had enough PrEP circulating in their bloodstream to confer HIV protection. That suggested that those participants had stuck to the short-term protocol.

None of the men contracted HIV while on vacation, even though nearly three-quarters reported having had unprotected sex. About one-third said they’d also used recreational drugs.

The study results, published recently in the Journal of Acquired Immune Deficiency Syndromes, were encouraging, said Egan.

“We found that the men in this study were able to take and be adherent to PrEP before, during and after their vacation,” he said. “So that is pretty great.”

Even better was the finding that nearly seven in 10 of the men said they were inclined to continue taking PrEP more permanently, suggesting that vacation PrEP can be a bridge to more regular use, the study authors said.

If so, that would be great news in the effort “to scale up PrEP use” among vulnerable populations, said Gregorio Millett, vice president and director of public policy for amfAR, The Foundation for AIDS Research.

‘Very liberating’

“PrEP is an essential tool in efforts to end the HIV epidemic,” said Millett. “Studies of gay men in the United Kingdom and Australia show dramatic reductions in HIV infections when drugs to control HIV infection [antiretrovirals] and drugs to prevent HIV infection [PrEP] are both scaled up.”

That thought was seconded by Dr. Michael Horberg, who directs HIV/AIDS and STDs for the Kaiser Permanente and Care Management Institute in Rockville, Md.

PrEP “is highly effective if you take the pill daily,” Horberg said. “It’s even better if you practice safer sex also [as the CDC recommends] but works for most even if you don’t.”

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According to Horberg, the problem in terms of adherence is that PrEP “requires taking a medication daily for an infection you don’t have yet. And some don’t have sex regularly, so it can be seen as a burden to take the medication if you are not that frequently sexually active.”

For his part, Anthony said his foray into short-term PrEP has paid off.

After being given “very specific instructions” by his doctor on taking the regimen, Anthony said he’s been taking PrEP for limited periods now once or twice a month.

The not so fun part? The nausea he experiences at the beginning of each regimen which, Anthony said, “I think is not a problem if you take it every day.”

And because it’s not part of his everyday routine, he pointed out that “it can be easy to forget to take it when I should. I have never actually forgotten, but I know it’s possible, so I’m careful.”

Still, the upside is worth it, Anthony said.

Taking PrEP on an as-needed basis is “very liberating. I’m kind of happy about it because it makes sex much more spontaneous and fun,” he added.

Horberg believes that “the ‘vacation’ regimen is gaining momentum.” Still, he said that he thinks permanent daily use is easier given that “most can’t predict when they will have sex.”

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SOURCES: James Egan, MPH, PhD, assistant professor, department of behavioral and community health sciences, Graduate School for Public Health, University of Pittsburgh, Penn.; Gregorio Millett, MPH, vice president & director of public policy, amfAR, The Foundation for AIDS Research; Michael Horberg, MD, MAS, director, HIV/AIDS and STD, Kaiser Permanente and Care Management Institute, Rockville, Md.; Tony, PrEP patient, Medford, Mass.; Journal of Acquired Immune Deficiency Syndromes, Aug. 15, 2020

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