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Possible side effects of prep: short-term and long-term

PrEP, or pre-exposure prophylaxis, is a method for HIV prevention that involves the use of antiretroviral medications. PrEP can help HIV-negative people reduce the risk of getting HIV if they are at high risk. There are two FDA-approved medications for PrEP: Truvada and Descovy. Both of these medications contain a combination of two drugs in a single oral tablet. PrEP medications are safe and effective at preventing the transmission of HIV when taken correctly.     

PrEP can empower you to take control of your health and protect yourself from contracting HIV. Like other medications, however, there may be doubts about using PrEP. Is PrEP safe? Or does PrEP have side effects?

Continue reading to learn more about the safety of PrEP, including the potential side effects of PrEP.  

Does PrEP have side effects?

Most of the medications we take may have potential side effects. It is a matter of balancing the benefits and risks. Every person will react to various drugs differently. Nevertheless, most people don’t experience side effects from PrEP. And if they do, these side effects are often well-tolerated. Studies state that PrEP side effects are mostly reversible and rarely lead to severe diseases. 

The FDA prescribing information has listed three common PrEP pill side effects. In a review of over 10,000 people, at least 2% experienced headaches, abdominal pain, and weight loss. Nausea, vomiting, and gastrointestinal problems occurred in 3.8% of people who took PrEP. The incidence of other side effects includes 2.4% for kidney problems and 1.7% for bone problems. Overall, few people experienced these side effects in clinical trials.  

Not all reported problems in clinical trials are attributed to PrEP side effects. Factors like pre-existing diseases, medicine interactions, and other factors may increase a person’s risk of side effects. The side effects may be misunderstood by the public as severe cases of kidney or bone toxicity. However, many of the people who experienced these side effects may have already been at risk of kidney or bone disease before taking PrEP. 

Healthy and younger individuals rarely experience any side effects. Like with most prescription medicines, people over 50 or those with illnesses are more likely to be the ones at risk of side effects. Still, the FDA and CDC have set limits for patients that can take PrEP. It’s best to tell your doctor about any medical conditions you have or medicines you may be taking before starting PrEP. You can also report any side effects you experience. 

What are the most common side effects of PrEP?

Reported PrEP side effects include:

  • Nausea
  • Vomiting
  • Headache
  • Stomach or abdominal pain
  • Diarrhea
  • Tiredness or fatigue
  • Depression and anxiety
  • Loss of appetite 
  • Weight changes (weight gain or weight loss)
  • Trouble sleeping 

The most common side effects are headache, abdominal pain, and weight loss. Gastrointestinal issues like bloating, gas, and constipation, may also be experienced with PrEP. Certain side effects like dizziness, depression, and rash may be more common in people who use Truvada for HIV treatment instead of PrEP. 

Short-term side effects of PrEP

You may be more likely to experience short-term side effects when you first take PrEP medication. This is called the start-up period and often happens in the first few weeks. Short-term side effects are tolerable and disappear in a few weeks.

Short-term side effects of PrEP may include nausea, abdominal pain, vomiting, headache, and fatigue. These side effects usually go away without stopping PrEP treatment. However, if the severity of PrEP medication side effects increases, you should consult your doctor. You may be advised to take the tablet with meals or treat the side effects with over-the-counter drugs.  

Long-term side effects of PrEP

Long-term side effects are quite uncommon. Over time, your body should adjust to the PrEP medication so you won’t experience as many side effects. In some people, side effects may arise over time that can affect their overall health. However, only a few individuals are susceptible to long-term side effects. Risk factors include age, duration of PrEP intake, kidney function, and potential drug interactions. 

In rare cases, liver health can be affected by PrEP. The liver can become large, tender, and fatty (steatosis). Another long-term side effect is kidney issues. PrEP medicines can decrease the kidneys’ filtering capacity because they stay in the bloodstream for a long period of time. Therefore, your doctor may reduce the dosage of your tablet. Loss of bone density is also a potential long-term side effect. In a few individuals, there are risks of developing bone fractures. However, studies state that this bone density loss is reversible and mild.  

The medicines used for PrEP have a difference in composition and their effects. The significant side effects of Truvada include kidney and bone problems. These side effects may occur less frequently in those who take Descovy since Descovy may have less of an impact on kidney and bone health. However, Descovy may be more likely to increase cholesterol levels than Truvada. In comparison, Truvada may cause cholesterol levels to decrease. 

In general, if you become positive with HIV, your risk of kidney and bone issues is higher. This is because HIV-positive individuals may experience more health issues and an increased risk of side effects from the use of multiple antiretroviral medications.

Is PrEP 100% safe?

PrEP has been a safe and well-tolerated treatment for more than a decade. The stigma on the side effects of taking PrEP pills may cause fear to some. Nevertheless, the benefits and efficacy of PrEP implementation continue to be recognized. 

Your healthcare provider should evaluate you to ensure you are eligible to take PrEP. Even so, PrEP requires a commitment to the dosing schedule to guarantee the best protection and safety. Overall, the benefit-risk ratio of PrEP treatment is favorable.

Before taking PrEP, you should be tested for HIV because an active HIV infection may become resistant to the drug if it is used alone. Additionally, PrEP prevents HIV but not other sexually transmitted diseases. Practice safe sex by using condoms along with PrEP pills to increase your protection from other conditions.

As a method of pre-exposure prophylaxis, PrEP is only recommended to HIV-negative people. PrEP acts by stopping HIV from attacking your body’s immune cells. When you take PrEP daily, the amount of drug in your bloodstream can stop the virus from reproducing and block pathways that cause infection. 

However, there may be other ways to take PrEP, such as the on-demand, or event-based, method. Periodic PrEP may also be effective and safe to use. Certain people may choose to take PrEP on demand if they are concerned about side effects with daily use. 

Some individuals may decide to stop taking PrEP for specific reasons. You may want to permanently or temporarily stop taking PrEP if: 

  • Your risk of getting HIV becomes low due to lifestyle changes
  • You often forget to take your pills 
  • You’re concerned about the PrEP medication cost and availability
  • You cannot tolerate or manage the side effects
  • You are allergic or sensitive to the medication    

If you decide to start PrEP treatment again, you will need to take another HIV test before you start. You will not be eligible for pre-exposure prophylaxis if you have been exposed to HIV in the last 72 hours after stopping PrEP.  

If you forget a dose, take the tablet immediately. However, if it is almost time for the next dose, skip the missed dose. Do not take a double dose to make up for it. A missed dose will not significantly affect PrEP efficacy. But, if you often forget to take your medication, the risks of an HIV infection may increase.

PrEP reaches maximum protection during anal sex after about 7 days of consistent use. It reaches maximum protection during vaginal sex and injection drug use after about 21 days. 

Bottom line
The benefits of PrEP treatment to people at high risk of HIV infection outweigh the side effects of PrEP. Its efficacy, when taken as prescribed, is over 90%. PrEP side effects are manageable and usually go away on their own with consistent use. More data continues to come out regarding the safety and effectiveness of PrEP, especially with different dosing schedules.

PrEP treatment offers effective HIV protection and empowers individuals to take control of their sexual health. PrEP goes beyond traditional barrier methods of protection and provides another option so you can enjoy your life without the risk. It provides you the sense of security that you are protected from HIV. Freedom of choice and peace of mind for your health is the best side effect of PrEP. 

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How long do PrEP side effects last?

PrEP side effects that are short-term are more prevalent in the first week of use and usually subside after a few weeks or a month. These reported side effects gradually resolve without having to stop taking PrEP tablets. 

Nausea usually passes after the first few weeks, and infrequent diarrhea may go away after three to four weeks. Some people find that taking a PrEP tablet with meals can ease gastrointestinal side effects. Other side effects like headaches may disappear within a few weeks to a month. Your doctor may recommend over-the-counter medicines to aid in managing the side effects. 

If you decide to stop taking PrEP medications, inform your healthcare provider before you do so. There are risks if you abruptly stop your medications. Your doctor will evaluate your condition and complaints to assess if there is a need to stop taking PrEP. Furthermore, before stopping PrEP, your doctor will conduct a test for hepatitis B infection (HBV). An active HBV infection could worsen if you stop taking PrEP.       

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