The next step in the fight to end the transmission of HIV has found its way to Shreveport.
In 2012, the FDA approved a combination of two HIV medicines for daily use to help prevent individuals from getting HIV from a sexual partner who’s positive. The concept of taking HIV medicines daily to lower the chance of getting infected from a partner living with HIV — more commonly known as Pre-Exposure Prophylaxis — recently caught the attention of local advocates, and many have now dedicated resources and time to educate northwest Louisiana on its benefits.
Chip Eakins, advocacy coordinator for The Philadelphia Center in Shreveport, has presented the benefits of the drug to about 50 people locally. He plans to target universities in the future.
Eakins recently embarked on a journey as educator and proponent of PrEP.
“I wanted to know firsthand how easy or difficult it would be to get on it,” said Eakins, who writes about the process, expense and side effects associated with PrEP on his Philadephia Center blog.
Eakins, who does not have HIV, began taking the drug in January.
“I may meet someone who is HIV positive that I want to be in a relationship with and this will make it less stressful for me and for them,” he said.
What is PrEP?
PrEP is a general treatment term for specific types of medication taken to prevent the transmission of HIV.
At present, the only medication approved by the FDA for PrEP is Truvada, a pill manufactured by Gilead. The drug combines two anti-HIV medications — Emtriva and Viread — in a single tablet form. In addition to its approval for use in prevention, Truvada is used in conjunction with other medications to directly treat HIV-positive patients.
A 2012 study that led to FDA approval of the medication for PrEP, found a great reduction in the transference and transmission of the virus between parties as compared to those who received a placebo. The study included heterosexual couples with one partner who was HIV positive.
Since its approval for PrEP, Truvada is a medication that has found its way into dating profiles and modern social consciousness — particularly in the gay, bisexual and transgender communities — more specifically between men who have sex with men.
In a known case of an individual believed to be adherent to PrEP contacting HIV, transmission was believed due to the fact the individual had sexual contact with someone with a strain of HIV highly resistant to treatment.
The Centers for Disease Control recommends patients taking Truvada do so daily for the maximum amount of protection. Men who have sex with men can expect maximum benefits to begin within seven days, but benefits for women can take longer to reach maximum potential.
“It’s the same thing as being adherent to HIV medications in a way,” said Eakins. “They tell people that are HIV-positive that you must adhere to your regimen and take your medicine every day or your virus is going to rebound. They won’t be undetectable anymore.”
People with HIV may refer to themselves as detectable or undetectable, but it’s clear that others may not understand what these terms mean.
“Undetectable means there is not enough virus in your blood stream to show up on a test,” said Eakins. “You’re still positive and less likely to transmit the virus, but you’re still positive.”
HIV-positive individuals who say they are undetectable are 98- to 99-percent less likely to transfer the virus, but viral loads in patients can fluctuate, particularly when they are less adherent to their medication regimen, according to Eakins,
“There’s only so many medications out there,” he said. “You’re playing Russian roulette when you start adhering and then not adhering.”
Access to PrEP
Agencies such as Acadiana CARES in Lafayette and The Philadelphia Center in Shreveport focus on educating the public on HIV prevention, helping the public access testing, and assisting in the procurement of medications for prevention and treatment. .
High risk individuals without HIV, particularly those with multiple sex partners, should educate themselves on PrEP, said Eakins.
PrEP is not a substitute for condom use. However, when combined with other forms of risk reduction, it will decrease — or eliminate — rates of new infections of HIV, especially among those aged 14 to 24. Increased rates of infection are showing in that particular age group, mostly among males who have sexual contact with other males.
Rates also are increasing in the African American community and in populations where economics, discrimination, and easy access to medical care are major barriers to education, prevention, testing, and treatment, Eakins said.
The goal of PrEP treatment is to eliminate new cases of HIV, but information and education are the first steps toward achieving that goal, he said.
The next barrier is accessing the medication.
How patients access Truvada
Access to PrEP is one of the largest challenges at this time, according to Thomas Huseby, a case manager for people living with HIV at Acadiana CARES in Lafayette.
He said some medical providers are not yet aware of PrEP and some may be uncomfortable prescribing it. There also are many perceived complexities in prescribing anti-HIV medications.
Primary care providers can prescribe PrEP after determining an individual meets the criteria set by the screening process, he said.
“Primary care providers can and should prescribe PrEP when appropriate,” said Huseby.
Many people, including medical providers in the community, believe only infectious disease specialists can write prescriptions for the medication, but that is not the case, according to Huseby.
“Prescribing PrEP essentially guarantees each patient will have a minimum of four medical visits each year,” said Huseby of what he believes could be an otherwise missed opportunity for Louisiana physicians.
Huseby said many potential PrEP patients are younger and otherwise less likely to regularly visit a doctor. “PrEP is an unrealized revenue maker.”
The CDC has guidelines for medical providers on how to properly prescribe PrEP, and those guidelines include a set of criteria that can help a medical provider determine what patients should be considered for the medication.
There are multiple resources for medical providers to consult when they have questions regarding the treatment, Huseby said. He hopes more providers in the state of Louisiana will do so because of limited availability to the medication in many areas.
“Your primary care physician is the one person you should tell everything,” said Eakins who noted that there is much more to Truvada than simply taking the medication every day.
Patients on PrEP should be fully educated on the medication and should report to their physicians for regularly scheduled tests on kidney function, liver function, bone density and continued HIV testing.
“To be on PrEP, you have to be negative,” said Michael Freeman, the wellness coordinator for the Wellness Center at The Philadelphia Center.
Freeman assisted in starting a PrEP clinic in Monroe in 2014. It exists as a point of access and follow-up testing site for patients. Freeman is working to create a similar clinic in Shreveport. His first step is to find a physician with whom to collaborate. Freeman typically does all the footwork, paperwork, and follow-up testing involved with running such a clinic and needs a doctor to open the clinic.
Although Freeman said the process is off to a slow start, he hopes to find the right medical collaborators to help him very soon.
Costs associated with PrEP
Truvada retails for about $1,500 per month because it is a top-tier specialty drug. Its manufacturer Gilead offers programs for assistance with the cost through their website, said Huseby.
“It’s not inexpensive, but it’s accessible,” said Eakins, who noted that coverage from health insurance varies among plans. Gilead offers a co-pay assistance card that can defer some or all of the cost left after insurance has paid. The manufacturer also offers different programs for those without insurance.
“It’s a lot less expensive than lifetime treatment,” said Eakins, who hopes to continue seeing more programs and medications to eliminate new cases of HIV in the community.
Did you know there are different forms of HIV?
- When HIV replicates by infecting a new cell, mutations can occur and there can be different types of HIV, even within a single person living with HIV. HIV-1 and HIV-2 are two totally different viruses. HIV-1 is the predominant virus worldwide, while HIV-2 is particularly concentrated in West Africa.
- The strains of HIV-1 are classified into four groups. Group M is the major group because it is responsible for the majority of the global HIV epidemic. Groups N, O, and P are mainly found in areas outside the United States.
- Groups are further divided into sub-types. HIV-1 has at least nine genetically distinct sub-types and geographical patters can start to emerge when looking at the various sub-types.
Steps to accessing and taking PrEP:
1. Get Educated!
2. Get Tested!!
3. Go to your primary care doctor and tell her/him everything — doctors are not mind readers and they are of maximum assistance when they know everything they can about you and your body.
4. Take the medication daily. Missed doses show reduction in the efficacy of the drug.
5. Continue to meet with your doctor for routine follow-up testing and care
Sources: Chip Eakins of the Philadelphia Center and avert.org