PrEP to end the HIV epidemic
8/14/2023 by Matthew Heinrich, M.D., M.B.A. and Denise Dupras, M.D., Ph.D.
In the 30 years since the human immunodeficiency virus (HIV) epidemic began, many treatment options have been developed that safely and effectively treat HIV. Today, people living with HIV have a normal life expectancy while on consistent treatment. Despite this achievement, the rate of new HIV infections has not improved, with nearly 40,000 people diagnosed each year in the U.S. With this in mind, pre-exposure prophylaxis, or PrEP, is now recommended for those at increased risk for HIV infection through sex or injection of recreational drugs.
What is PrEP?
Pre-exposure prophylaxis (PrEP) is a medicine taken to prevent infection with HIV. PrEP works by preventing HIV from replicating within the body in people who have not been previously exposed to HIV. For most patients, PrEP is a once-daily pill that must be taken consistently, though long-acting injections have also been developed. PrEP is highly effective when taken as prescribed, reducing the risk of getting HIV from sex by about 99%, or about 74% from injection drug use. Even with PrEP, condom use is still important to protect against other sexually transmitted infections.
Who might be eligible for PrEP?
PrEP is not for everyone but is recommended for those at elevated risk for HIV infection. This includes sexually active adults and adolescents with any of the following:
- History of inconsistent or no condom use during sex.
- HIV-positive sexual partner.
- Sexually transmitted infection, such as gonorrhea, syphilis or chlamydia, in the past 6 months.
For people who inject drugs, PrEP is recommended for those who share injection equipment or who have an HIV-positive injecting partner.
How can I start PrEP?
If you think you are at increased risk for HIV, reach out to your local care team. If you and your care team agree that PrEP can reduce your risk for HIV, you will need to be seen for a general exam, blood testing for HIV and other sexually transmitted infections, and testing of your kidney function to ensure PrEP medications are safe for you. After starting PrEP, you must regularly follow up with your care team for monitoring tests.
When used appropriately, PrEP is highly effective at preventing new HIV infections and continues to be a powerful tool to help end the HIV epidemic.
Visit these websites for more information about HIV risks:
- HIV Risk Reduction Tool (Centers for Disease Control and Prevention).
- Estimate the HIV Risk (Centers for Disease Control and Prevention.
Matthew Heinrich, M.D., M.B.A., is an internal medicine resident in the Department of Medicine Primary Care Clinic located in the Baldwin building in Rochester, Minnesota. He earned his medical degree at Texas Tech University Health Sciences Center School of Medicine in Lubbock, Texas. His interests include primary care, evidence-based medicine and care of LGBTQIA+ patients.
Denise Dupras, M.D., Ph.D., is a Community Internal Medicine, Geriatrics and Palliative Care physician at Mayo Clinic in Rochester. She earned her medical and doctoral degrees at Mayo Clinic Alix School of Medicine and completed her residency in internal medicine at Mayo Clinic in Rochester. Her interests include medical education, evidence-based medicine and care of LGBTQIA+ patients.