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Those interested in taking part in clinical trials for HIV prevention – including the REV UP clinical trial – can contact Sherri Karas Certo by calling or texting 412-818-4942 or emailing Sjk91@pitt.edu.
When PrEP (pre-exposure prophylaxis) became available in 2012, it was a game changer. By taking a once-daily pill, people could be 99% protected against HIV infection. Today, people can choose between daily pills or injections for PrEP, and even more options are on the horizon.
Dr. Ken Ho is a renowned infectious disease expert and former Allies for Health + Wellbeing board member and vice president. He currently serves as medical director of the Pitt Men’s Study. He says that having multiple options for PrEP allows people to choose what works best for them.
“Everybody has a different life, they have different partnerships with people,” he said. “We also acknowledge that our patients lives are complicated and having more options can help them protect themselves better.”
For those who don’t want to take a pill every day, injectable PrEP is a newer option. Allies for Health + Wellbeing offers Apretude, an injection that patients receive every other month.
“It’s been well-received in many places,” Ho said. “The main side effect is literally pain in the butt.”
He added that adherence to the PrEP routine and scheduling appointments for future injections can be a challenge.
“That said, for many people, not having to take a pill once a day is liberating,” he said.
Dr. Sarah McBeth, medical director for Allies for Health + Wellbeing agrees.
“For a lot of people, it’s lifestyle choice,” she said. “Would you rather show up at the doctor’s office every two months for that medical appointment, or would you rather take a pill every day? For some people, for any given person, one or the other is a better option.”
Whether you choose pills or injections, Ho said that the two PrEP methods are equivalent in terms of protection against HIV.
“Both work really well,” he said. “I think the big challenge is it’s important to follow up and not get lost.”
Ho and McBeth noted that studies are very promising for a PrEP drug called lenacapavir, which can be given as an injection every six months instead of every other month. The drug is currently undergoing clinical trials, but initial results have shown 96% protection from HIV in cisgender men, transgender men, transgender women, and gender non-binary individuals who have sex with partners assigned male at birth. Among cisgender women in Africa, a trial of lenacapavir offered 100% protection from HIV.
“That would change the face of HIV care,” McBeth said. “That would be amazing for our patients.”
As part of his work at the University of Pittsburgh, Ho is part of a team running clinical trials on PrEP in the form of a douche or enema.
“People use enemas and douches for hygiene and preparation for sex,” Ho said. “Wouldn’t it be great to combine something protective with something that’s preparation for sex?
“The REV UP study – HPTN106 – looking to enroll people around the country to try out this douche for a couple months and then try out on-demand oral PrEP with Truvada for a couple months and basically compare the two,” Ho said.
Ho said that using a douche for PrEP gives people an option that’s “event-driven.” Rather than a regular pill or injection, which offers ongoing protection, a douche can be used whenever a person plans to have sex.
Ho added that a PrEP douche concentrates the medication in the rectal canal, where an HIV exposure would take place.
“You get lots of PrEP where you need it, but you don’t get it anywhere else in the body,” Ho said, noting that this can be a benefit for people who are worried about medication side effects.
With new options for PrEP coming on the market and in the pipeline, it can be difficult for providers and patients to keep up with what’s available.
“It’s one of those fields where there’s a lot happening – it changes a lot,” Ho said. “I feel like we see it a lot where providers are less knowledgeable and shut down the conversation, and I think that’s a detriment to the community at large.”
He said that patients should feel comfortable talking to their provider about their PrEP options, and if a provider is resistant, there are knowledgeable practitioners available.
“If the answer is, ‘No, you shouldn’t be on this,’ people should feel empowered that it should never be a ‘no,’” he said. “There should be a discussion around PrEP.”
Allies for Health + Wellbeing offers oral and injectable PrEP for HIV prevention. If you are interested in learning more about PrEP, call 412-345-7456 or visit AlliesPGH.org to schedule an appointment with one of Allies’ providers.
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