In April 2014, the Washington State Department of Health introduced a drug assistance program to help eligible individuals get medication that significantly reduces their chance of HIV infection. The daily prescription drug, Truvada, contains two antiviral medications that inhibit the replication of HIV. When taken correctly Truvada is shown to be highly effective at preventing infection for adult men and women with certain risk factors, including having an HIV-positive partner.
Part of a therapy known as Pre-exposure Prophylaxis (PrEP), Truvada’s cost makes it out of reach for many, even with insurance coverage. Washington state health officials were among the first in the nation – along with the Centers for Disease Control and Prevention and the World Health Organization – to identify the public health benefits of PrEP, making affordable access to the drug a key strategy in the fight against HIV.
Patients complete the application for Washington’s PrEP Drug Assistance Program jointly with a prescribing physician, and that’s where an infectious disease specialist like Shingo Chihara, MD, comes in. Dr. Chihara identifies risk factors that determine which patients would benefit from PrEP therapy and completes the required screening, including for HIV and other sexually transmitted infections (STIs).
“We counsel patients about safe sex and other STIs, because Truvada does not protect against bacterial infections like syphilis, gonorrhea and chlamydia,” says Dr. Chihara. “I see patients about every three months, when we also repeat an HIV test. We’d never want to treat a patient with acute HIV infection with Truvada because it wouldn’t work and could lead to drug resistance.”
Physician guidelines for administering PrEP were developed by the Centers for Disease Control and Prevention in collaboration with other agencies and health experts. PrEP should be considered for men or women who are in a sexual relationship with an HIV-infected partner, or with someone at high risk of becoming HIV-positive. PrEP indicators for men who have sex with men include recent exposure to or diagnosis of an STI, 10 or more sexual partners within the last year, and certain types of illicit drug use.
Dr. Chihara cautions that PrEP is only effective when taken consistently every day, and requires regular follow-up care, including kidney function tests, to monitor possible side effects. Also important is the ongoing dialogue with patients about sexual safety and the limits of PrEP.
“As long as the patient stays on the regimen and complies with follow-up care, PrEP is very effective,” says Dr. Chihara. “We want to get the information out there. The good thing is Washington residents may be eligible for the assistance program if they need help paying for the therapy.”