When taken as prescribed, PrEP blocks HIV from taking hold in the body, even if you were to come in contact with it. Canadian experts agree that uninterrupted daily use of PrEP is a highly effective strategy for reducing the risk of infection with HIV in adults who are at high, ongoing risk of infection.

PrEP is a pill for people who do not have HIV who want added protection. It contains two anti-HIV drugs called tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC). The common brand name of this medication is Truvada® but the combination pill of TDF/FTC is now available in Canada as a generic formulation.

In Canada, PrEP has been approved as a once daily medication to be taken consistently, every day. Your provider may have discussions with you about other studies and methods of taking PrEP, depending on your lifestyle and risk. For now, PrEP is taken as 1 tablet, once daily, with or without food.

Many people on PrEP report no or minimal side effects. Others may at first experience mild symptoms such as headache, abdominal pain and weight loss. These side effects tend to go away after about a month of being on PrEP. If you have any questions or concerns about side effects, consult your health care provider or one of our HIV expert pharmacists at 1-800-727-5048 or email pharmacist@pharmacy.ca

Long term use of PrEP may lead to a modest decline in kidney function and bone density. Your provider will monitor this and studies have shown that both of these declines are likely reversible after stopping PrEP. 

You will need to obtain a prescription for PrEP from a health care provider, such as a medical doctor or nurse practitioner. Once you have found a provider or health center that provides PrEP, you will likely be asked some questions to help you determine if PrEP is a good fit for you. This may include questions about your sexual history and your use of condoms. Before you can start PrEP you will need to take an HIV test to ensure you do not already have the virus, as well as have your kidney function checked and be tested for hepatitis B and C viruses.

Once the test has confirmed you don’t have HIV, you can get a prescription for PrEP. Sometimes the first supply will be for one month, after which time you will be asked to return so your provider can see how you are responding to PrEP. If all is going well, you should receive three-month prescriptions from there on out. This means you’ll need to have check-ups four times a year, at each of which you’ll be re-tested for HIV as well as possibly have other labwork including screening for other sexually transmitted infections (STIs).  

Your family doctor or nurse practitioner can prescribe PrEP, there are no special requirements or certification required. If your health practitioner is unfamiliar or reluctant to undertake PrEP therapy there are several web-based resources that may help you identify a physician who prescribes PrEP. One such Ontario based resource** is http://thesexyouwant.ca/prep/where-to-get- prep/ 

** Please note that we provide this link as an information resource only and not as an endorsement or verification of any practitioner listed. You are responsible for determining the suitability of any practitioner on any web based resource list.

PrEP only protects against HIV. Routine screening for sexually transmitted infections (STIs) is part of maintaining a prescription for PrEP. Going on PrEP can help you more promptly diagnose and treat any STIs you may contract. We know that consistent use of condoms provides protection against other STIs, in particular gonorrhea and chlamydia. For that reason, condoms are still recommended as part of safer sex strategies.

If you miss any doses, try to get back on a daily schedule as soon as possible. Missing a single dose will not likely effect the level of protection PrEP offers from HIV. Missing multiple days can be more problematic. If you are having difficulty keeping up with the daily schedule you may want to discuss this with your health care provider.

Just as your lifestyle may change, so may your level of risk of being infected with HIV. You can go on and off PrEP, but should do so under the guidance of a health care provider. Before restarting PrEP you will need to get tested again to make sure you do not have HIV.

If someone uses PrEP but for some reason has already been infected with HIV, their virus may develop resistance to TDF/FTC. Since this combination is also found in more potent combinations that are used to treat HIV, this may limit treatment options for that person. Testing you for HIV every 3 months ensures that you still do NOT have HIV. Keep in mind, however, that as long as you take PrEP daily as prescribed, your risk of contracting HIV is extremely low.

At the routine visits required to stay on PrEP, your health care provider will also likely monitor you for any side effects of the drug and may provide helpful counseling on lowering your risk of HIV and other STIs. Also, you’ll get kidney function and other labwork done as deemed necessary by your health care provider.

As long as you are taking PrEP as prescribed, alcohol and drug use should not directly affect how well PrEP works. However, substance use may affect how consistently you take the medication. Missing doses can lower PrEP’s effectiveness.

Tan D, Hull M, et al. Canadian Guidelines on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis. CMAJ 2017 November;189:E1448-58.doi:10.1503/cmaj.170494

http://www.cmaj.ca/content/189/47/E1448

#BePrEPd™ is an ongoing, confidential and convenient delivery program that works with your health care provider to ensure that you receive your PrEP prescription in the most timely, affordable, and confidential manner. #BePrEPd™ also gives you access to a team of pharmacists who are expert in HIV treatment and prevention. With #BePrEPd™ your privacy is our priority!

Your medications are packaged for privacy, security and confidentiality and they are double boxed.

• The outside box contains the name and delivery address you provide and our return address only (no pharmacy name appears).
• The inside box is sealed with tamper proof tape and has only your name on the outside,
• Your medication and any paperwork, receipts, etc, are inside the inner box

If you have ODB coverage you will not pay for your PrEP medication* nor the delivery. Keep in mind that in Ontario, youth up to the age of 25 years are now fully covered for medication through OHIP+. All that is needed is a valid Ontario Health Card. If you have private coverage you will pay your usual co-pay depending on the terms of your plan. Delivery is free.

*Plan deductibles or co-pays may apply.

Pharmacy.ca is a Toronto-based pharmacy with over 20+ years of experience and specialized knowledge in HIV care and prevention. Although we are a stand-alone pharmacy located at 311 Sherbourne Street (at Gerrard) in Toronto, we also pride ourselves in having one of the most successful provincial delivery programs of our products and services where your privacy is our priority.

You or your healthcare provider can reach our highly specialized pharmacy team toll free at 1-800-727-5048. We will also answer email queries at pharmacist@pharmacy.ca