Q&A WITH DR. KEV

We The Brave sat down with Dr. Kevin Rebe, our go-to guy at Health4Men and Infectious Diseases specialist to talk about PrEP. Dr. Kev has been working in HIV for the last decade and is focused on prevention and rolling out PrEP (Pre-Exposure Prophylaxis), the latest HIV prevention treatment to come out during the fight against HIV. We’ll be chatting to him a lot as we get closer to PrEPbeing made available in South Africa from June of this year.

What is PrEP?

PrEP is a strategy of taking antiretrovirals for HIV prevention. The original studies on PrEP used a drug called Truvada, which contains two ingredients (Tenofovir and Emtricitabine) that have been used for years for HIV treatment. PrEP is part of a menu that gets offered as a holistic package of HIV prevention that includes condoms, STI screenings and treatment, lubrication, some counseling, guidance and daily adherence to taking a pill a day.

How should we take PrEP?

Firstly, PrEP is not a lifetime intervention. PrEP is to be used while you have the potential to be exposed to HIV. So let’s say I’m single and I’m dating and I have multiple partners in a month and my condom use is inconsistent. Then I might decide that I’m going to start taking PrEP. That’s the perfect candidate and is only to be taken every day for a period of time and not a lifetime.

What can we expect when we take it and how it affects our lives?

There is a ‘lead in’ period. I don’t want to call it a ‘window period’ because it confuses it with HIV treatment (ARVs) but there is a lead in period and that is about seven days for anal sex and about 30 days for vaginal sex. This message has to be clear. I would start the pills, note the lead in period of seven days and thereafter I would take it daily while I had the potential to be exposed to HIV, having multiple sexual partners and dating various people.

Then hypothetically, I meet the partner of my dreams and I stop taking PrEP because the relationship is closed. Then perhaps a year later, the relationship breaks up and I decide to go back onto PrEP. We call this way of taking it ‘cycling’. PrEP is a daily strategy but it is not a life long strategy and I think that is where the message is getting diluted.

Why would you not take PrEP for your whole life?

As with everything there is a risk balance equation that gets assessed. Tenofovir and Emtricitabine are pretty benign but not entirely side effect free. There is nothing you take that is side effect free. With Tenofovir there is the risk of renal dysfunction or kidney failure that is predictable and can be monitored. We test for it and would stop the PrEP immediately if this was the case, after which everything with the kidney returns back to normal. You do have to keep checking this. The other thing is bone density, which could turn out to be a red herring and not worth worrying about. But, you wouldn’t want to take any risks unless there was definite benefit to taking PrEP. In other words, there is a real risk of contracting HIV without PrEP. So if I were to put somebody who was not sexually active on PrEP, it would not be the correct practice.

So what’s the first step?

Get tested. PrEP can only be taken if you are HIV negative. Find a clinic near you or come into Health4Men to know your status and see if you are an eligible candidate.