Ask the Doctor Your HIV Related Questions

My boyfriend is thinking about going on PrEP. Is that a good idea?

Maybe. In the war against the spread of HIV, doctors and patients have powerful new weapons, including pre-exposure prophylaxis, a.k.a. PrEP. As with any weapon, we must use PrEP with caution and respect lest it backfire, causing more harm than good. Based on recent studies, PrEP works by lowering the ability of HIV to establish infection after an exposure when taken daily (the risk of getting HIV is directly proportional to medication levels) and when used with condoms.

What you should know:
• You cannot miss doses. It is far too risky to conclude that even if you miss doses, PrEP may still provide reliable HIV prevention. And while the diagnoses of other sexually transmitted infections were not statistically different among study participants using PrEP compared to those who weren’t, the percentage of new STI infections in the PrEP group was certainly higher, suggesting a trend toward riskier sexual behavior (and reinforcing the importance of using condoms).

• There can be side effects. Side effects of PrEP are generally well tolerated. However, kidney or liver damage is a real risk. We’ll need some time and experience to link other factors—for example, alcohol use—with the risk of organ damage in people using PrEP.

• You need to have an honest discussion of risks, benefits, and side effects with your health care provider. Before starting PrEP, tell your provider if you have symptoms of a viral infection, and after starting, report unusual symptoms or side effects as soon as they occur.

After you start, it takes up to seven days for PrEP to be effective. And make sure you’re screened regularly for other STIs, many of which you may have and spread to partners
even with no symptoms. Misinformation on the correct use of PrEP may be as harmful as not
using PrEP at all.

Plus’s wellness editor Joseph Arcuri Jr., MD, has a private practice in internal medicine in New York City’s Chelsea neighborhood, with a focus on preventive medicine, men’s health, and HIV care. He’s also an assistant professor of medicine at the Icahn School of Medicine at Mount Sinai.