5 Things Canadians Should Know About PrEP

The HIV prevention drug is not for everyone, but it could soon be more accessible for Canadians.

A drug that, when taken daily, could greatly reduce the chances of becoming infected with HIV has been submitted to Health Canada for approval.

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Truvada is already approved and prescribed in Canada as an antiretroviral drug used to treat patients with HIV. However, it can also be taken by those who aren't positive as a way to prevent infection.

Known as PrEP (pre-exposure prophylaxis), studies have shown Truvada can reduce the likelihood of contracting HIV by up to 92%.

Its maker, Gilead Sciences Canada, has applied to Health Canada for official approval of Truvada as PrEP.

PrEP has been a controversial method in both medical and LGBT communities, so we asked two experts to break it down for us.

Courtesy of Casey House

Courtesy of CATIE

Dr. Ann Stewart is the medical director at Casey House, an HIV/AIDS hospital in Toronto and Sean Hosein is the Science and Medicine Editor at CATIE.

1. Doctors can already prescribe Truvada for PrEP in Canada.

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Truvada (which is a combo of tenofovir and emtricitabine) is already a legal, approved drug in Canada. That means doctors are allowed to prescribe it for other uses, using their own medical judgement.

That means a doctor — if they're comfortable doing so — could prescribe a patient a daily dose of Truvada. But, only if they're comfortable doing so.

"Because it's not formally approved some doctors might not want to prescribe it, they might feel leery about prescribing it," said Hosein.

2. It's expensive, but getting approval from Health Canada could change that.

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Truvada is definitely not cheap and because it's not approved as PrEP for HIV-negative patients, even private insurance plans are unlikely to cover it.

Daily Truvada can cost anywhere from $800 to $1,200 per month depending on the pharmacy and region of Canada. Quebec's provincial drug plan does provide coverage, however.

"One thousands dollars a month is a lot of money for most people and they would like to get their private insurers to pay for it, but it’s not officially approved for this use, so it’s hard to get," said Hosein.

Getting Truvada approved as PrEP by Health Canada potentially means more plans will cover it, greatly improving access for those who want it.

3. It's more involved than simply popping a pill everyday.

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"You've got to have some structure in your life in order to do this effectively," said Stewart.

Not only do PrEP users have to take their medication consistently, they'll need regular doctor's visits, including getting retested for HIV every three months. Hosein said its been shown to work best as part of a prevention package that includes counseling, medical support and safer sex strategies.

"It’s not like you take a pill and just forget about. You have to be engaged with the medical healthcare system," said Hosein.

For people who already have trouble accessing health care — like those living in poverty — obtaining that ongoing support could prove difficult.

"In Toronto, there was as study that found the 100 or so people that most needed Truvada were least likely to be able to get it, either because of income reasons or for other reasons," said Hosein.

4. The issues surrounding it have made PrEP a controversial topic in the medical community.

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Stewart said while Truvada is a well-tolerated drug with relatively few side effects, she and others have reservations about prescribing it as PrEP.

"I think people are not inclined to put patients on regular medication unless they have to," said Stewart. "Taking regular medication will always have potential problems. There's a downside."

Truvada does not protect against other sexually-transmitted infections, like chlamydia and gonorrhea. Hosein said there is some fear that users will forgo condoms once they start PrEP.

Compliance is another big worry, he said, since trials in the U.S. (where PrEP has been approved for several years) show it works best when taken everyday.

"But now that the major clinical trials are over and they're testing it in the community in the U.S., it seems that most people who request it and to whom it's prescribed do actually take it everyday," he added.

5. It needs to be part of a larger HIV prevention strategy to be effective.

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Hosein said that getting PrEP approved in Canada is "a good first step but there are a few more steps needed."

Ideally, he said, provinces and territories will start talking about how to incorporate PrEP into HIV strategies as another prevention tool. Programs in Boston and San Francisco, for example, have shown that patients on PrEP will keep up with regular testing when there's a plan for support in place.

"I don’t think Truvada’s for everybody because some people may not want to take a pill everyday," said Hosein.

"But for people who are high-risk, particularly for some men who have sex with men, I hope provinces and territories look at that and think, 'you know what, Truvada might be part of our strategy for reducing HIV infections in the future.'"

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