How safe is the PrEP?

With daily intake, the PrEP protects more than 99% against HIV. In the major studies (iPrEx, PROUD, DISCOVER) there were virtually no HIV infections with correct daily intake. The few breakthrough infections occurred with irregular intake.

Does the health insurance cover the costs?

Yes, since September 2019, the statutory health insurance companies in Germany take over the costs of the PrEP including the accompanying investigations. The prescription is carried out by HIV-focused physicians or especially legitimate practices.

Do I have to use condoms despite PrEP?

The PrEP protects only from HIV, not from other sexually transmitted infections such as syphilis, gonorrhoea or chlamydia. Condoms provide additional protection against these STIs and are therefore still recommended.

What if I forget a dose?

Take the forgotten dose as soon as possible. If it is almost time for the next dose, take only the next regular dose (not the double amount). For frequent forgetting, talk to your doctor about strategies.

Can I put the PrEP back?

Yes, but take the PrEP after the last risk contact for at least 2 days (in case of anal exposure) or 7 days (in case of vaginal exposure). With Hepatitis B: Just drop under medical supervision!

Truvada

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What is Truvada?

Truvada® and its generics (Emtricitabin/Tenofovirdisoproxil) are used for HIV-pre-exposure prophylaxis (PrEP). The PrEP is a prescription drug for HIV-negative persons with increased risk of infection, which protects over 99% from HIV infection when taken daily.

Since September 2019, the costs of PrEP in Germany have been taken over by statutory health insurance companies. The prescription is done by specialized doctors or HIV focal points. In addition to the Truvada® brand product, cheaper generic drugs are available which contain identical active ingredients.

Active Ingredients & Mechanism of Action

Active ingredient: Emtricitabin 200 mg + Tenofovirdisoproxil 245 mg

Active mechanism: Both active compounds are nucleosid reverse transcriptase inhibitors (NRTIs):

Emtricitabin: Is activated to emtricitabin triphosphate in the cell and inhibits HIV reverse transcriptase
Tenofovir: Is activated to Tenofovir diphosphate and also blocks reverse transcriptase

Protection mechanism:

The active ingredients are enriched in the cells that use HIV as an entry gate
In contact with HIV, the virus propagation is immediately blocked
The virus cannot spread in the body
An infection is prevented

Protection effect:

Daily intake: > 99 % protection against HIV
Full protection in anal traffic: after 7 days daily intake
Full protection in vaginal traffic: after about 20 days daily intake

Who is it suitable for?

PrEP with Truvada® is suitable for:

HIV-negative persons with increased HIV risk
Men who have sex with men (MSM) and changing partners
heterosexual persons with HIV-positive partner (without virus load suppression)
People who do sex work
People with changing sexual partners and inconsistent condom use
People with recurring STIs

Provisions:

Confirmed negative HIV test (before!)
Kidney function in standard range (GFR > 60 ml/min)
Regular medical checks (every 3 months)

Not suitable:

People with HIV infection (PrEP is NO HIV therapy!)
Restricted kidney function (GFR < 60 ml/min)
Acute HIV infection or unclear HIV status

Available Dosages

Every PrEP (standard):

1 tablet (Emtricitabin 200 mg / Tenofovir 245 mg) once a day

Running Time:

Anal traffic: 7 days daily intake for full protection
Vaginal traffic: approx. 20 days daily intake

**Event-based PrEP (for MSM only for anal exposure):* *

2 tablets 2–24 hours before sex
1 tablet 24 hours after the first dose
1 tablet 48 hours after the first dose
Continue taking at least 2 days after the last risk contact

**The event-based PrEP is only tested and approved for MSM (anale exposure).

How to Take

Adoption:

1 tablet daily, always at about the same time
Independent meals
Suck with water

Examinations every 3 months:

HIV test (before each new prescription!)
Renal function (Creatinine, GFR)
STI screening (Syphilis, Gonorrhoe, Chlamydien)
Hepatitis B status (before start)

Important notes:

Never start without previous HIV test!
In case of forgotten dose: as soon as possible repeat, then continue as usual
PrEP does NOT protect against other STIs – condoms still recommended
Renal function and hepatitis B status

Contraindications

**PrEP must not be accepted at:* *

HIV infection (also suspect!) – Risk of resistance development!
Sensitivity to Emtricitabin or Tenofovir
Kidney function disorder (GFR < 60 ml/min)

Preview at:

Chronic hepatitis B (travel of a hepatitis B-lare-up when decomposing!)
osteoporosis or risk factors for bone mineral density loss
simultaneous use of nephrotoxic drugs
Liver disease

When decommissioning: In hepatitis B co-infection: Do not drop abruptly! Danger of a heavy hepatitis B disc. Medical accompaniment required.

Possible Side Effects

**Acid (1–10 %) in the first weeks:* *

nausea (usually temporary, after 2–4 weeks better)
Headaches
diarrhea
fatigue
Squeeze

** Occasionally (0.1-1 %):* *

Blowing
Skin rash

Long-term side effects (same):

Easy kidney function restriction (reversible after depletion)
Low bone mineral loss (clinically not relevant)
Increased liver levels

** Most side effects occur in the first weeks and then sound. The PrEP is very safe in regular checks. Kidney function changes are reversible after settling.

Interactions

Contracted:

Other Tenofovir-containing medicines (avoid double dose)
At the same time with highly dosed Adefovir

Preview at:

Nephrotoxic medicines (NSAR for continuous use, aminoglycosides)
Ledipasvir/Sofosbuvir (Tenofovir mirrors can increase)
Didanosine (increased toxicity)

No problem:

Hormonal contraception ( pill, hormone spiral etc.)
Most popular medicines
Alcohol (measures)

Frequently Asked Questions

Is Truvada right for you?

A licensed doctor will review your information and issue a prescription if suitable. Discreet and secure.

Start therapy

Important Notice

This information does not replace medical advice. If you have questions about your health or the suitability of this medication, please consult a doctor. Read the package leaflet before use.