It is estimated that around 103,800 of people live with HIV in the UK (PHE, 2019). Estimated 17% of people with HIV are not aware of the infection (NICE, 2016), increasing the risk of passing HIV when having sex without protection. Truvada (emtricitabine/tenofovir disoproxil) is an antiviral drug used in the treatment of HIV, alone or as part of antiviral combination therapy. Truvada is also licensed as pre-exposure prophylaxis (PrEP) medication. Today, I am reviewing Truvada for PrEP. In summary, the following will be discussed:
- What is Truvada?
- Truvada for PrEP: how does it work?
- Truvada for PrEP: effectiveness.
- How to get Truvada
- Superdrug Pharmacy: Truvada for PeEP service
- Cost of Truvada in the UK
- Can you get Truvada on NHS?
- Common side effects associated with Truvada
- What to do when Truvada dose is missed
- Truvada: alternative options
Truvada for PrEP: how does it work?
Truvada is a brand name of a combination drug, which contains two antiviral medicines: emtricitabine and tenofovir disoproxil. Truvada is used in the treatment of HIV, but also for as pre-exposure prophylaxis (PrEP) medication. This post will cover the use of Truvada and its generic form for PrEP.
In plain language, both emtricitabine and tenofovir disoproxil stops viral DNA production and therefore stops spreading of HIV.
Pre-exposure prophylaxis (PrEP) is a process of preventing HIV infection by people who do not have HIV, who are, however, at high risk of being infected. PrEP involves taking a pill every day as part of prophylaxis (prevention) therapy.
When an individual is exposed to HIV, Truvada can stop the virus from forming a permanent infection. Although PrEP is effective in the prevention of getting HIV, using condoms additionally reduces the risk of getting HIV even more and protect from getting sexually transmitted diseases (STDs).
Patients are reminded that Truvada is not 100% effective. It is advised to use Truvada along with other preventative measures such as wearing a condom.
Truvada cannot be taken for PrEP by patients with unknown HIV status or pos-itive HIV status. This means patients need to be tested for HIV before initiation of the treatment.
The effectiveness of Truvada for PrEP
As a part of prophylaxis therapy, one Trevena pill is taken every day. Taking the medication at different times or forgetting to take has the most significant impact on reduced effectiveness of the therapy. One important message to take away is that Truvada and equivalent generic drugs are not 100% effective.
The effectiveness of Truvada for PrEP has been subject to different clinical trials. The ‘official’ NICE guidelines on the use of Truvada for PrEP looked at four clinical trials. Each trial looked into the reduction of HIV transmission between either HIV-negative men or transgender women who had sex with men or HIV-negative individuals in a heterosexual partnership with a person already infected with HIV.
Truvada reduced the (relative) risk of getting HIV infection between 44% and 86% as compared with a ‘dummy’ pill or no treatment at all.
Additionally, during all trials, patients were supported with HIV testing, risk-reduction cancelling, condoms and management of any STIs (NICE, 2016).
How long does Truvada take to work?
The time it takes for Truvada to work is unknown.
Trevena can stop HIV infection if a patient starts taking the pill within the 72 hours of exposure to HIV; however, it is the best to begin taking Truventa for PEP straight away after the exposure. This form of treatment is called Post-Exposure Prophylaxis (PEP). As part of PEP patient need to take one pill every day for 28 days.
How to get Truvada
So far, Truvada was officially available in England as a part of a clinical trial with enrolment into the trial between October 2017 and July 2020. With the recent announcement of a grant in England supporting the PrEP it will be possible to get a generic Truvada in some areas free of charge. The supply of a generic Truvada on NHS will most likely be processed by a sexual health clinics, rather than from a general practitioner (GP).
In the UK, Truvada is a prescription-only medication, which means a qualified prescriber (for example, a doctor) need to issue (write) a prescription. It is possible, therefore to get Truvada or its generic form privately as long as a doctor or another qualified prescriber determine the need for the drug. There is also a question of confirming the HIV status of the patient before any prescription is written. Although in theory, it would be possible to get a private prescription for Truvada, in practice, a private service offered by Superdrug, for example (see next section), is much more convenient and does not differ in price significantly.
You can learn how a private prescription can be obtained in one of my previous posts: Private prescriptions: cost, legality and FAQ.
Superdrug: Truvada for PrEP service (private service)
In recent days Superdrug started offering pre-exposure prophylaxis (PrEP) treatment service, which is available on Superdrug’s Online Doctor website. Superdrug’s PrEP service is a private service which allows patients to get a generic Truvada for Pre-exposure prophylaxis of HIV. The cost of the service includes a supply of the drug as well as a review of a questionnaire completed by patients and issuing of ‘private prescription’ by a doctor.
How does Superdrug PrEP work?
Firstly, patients need to complete a brief online questionnaire, which is then reviewed by a doctor who can prescribe generic Truvada for PrEP.
How much Superdrug’s PrEP service cost?
In the first instance, patients need to order ‘Introduction and Annual PrEP Test‘. This test uses a small amount of blood to determine HIV status, Hepatitis B & C status and your kidney (renal) function.
As discussed previously, patients need to be HIV negative to qualify for PrEP. The prices for PrEP service with Superdrug are as follows:
- Introduction & Annual PrEP Test: £99.99
- Generic Truvada (Emtricitabine/Tenofovir disoproxil) – one month supply: £80.00
- Generic Truvada (Emtricitabine/Tenofovir disoproxil) – two months supply: £155.00
- Generic Truvada (Emtricitabine/Tenofovir disoproxil) – three months supply: £220.00
In comparison, a 30-day cost of treatment with Truvada costs around £355 (excluding VAT).
Can you get Truvada on NHS?
At the end of September 2020, the Department of Health and Social Care (DHSC) published a grant guidance – HIV pre-exposure prophylaxis (PrEP) grant determination 2020 to 2021.
This grant provides support for local authorities toward expenditure caused by the supply of a generic drug as part of PrEP service. Annex B of the document list all local authorities which were awarded grants.
Publication of this document confirms that PrEP will be available in certain areas free of charge and on ‘NHS’. PrEP will be available in some sexual health clinics across the country.
Cost of Truvada in the UK
Superdrug is the first high street pharmacy to offer generic Truvada for PrEP with prices standing at £80 for a month’s supply of the drug. Since Truvada and its generic forms of the medicine are prescription-only medication, it would be possible to get a supply of this drug, for example, on private prescription as previously discussed.
AHH, one of the main pharmaceutical suppliers lists three generic forms of Truvada, which are produced by different manufacturers. There are several generic versions of Truvada. Generally speaking, generic drugs are cheaper than branded drugs. The trade prices for a pack of 30 generic Truvada tablets are as follows:
- Emtricitabine/tenofovir tablets 200MG/245 tablets (MG): £57.20
- Emtricitabine/tenofovir 200MG/245MG tablets (TEVA): £106.72
- Emtricitabine/tenofovir 200MG/245MG tablets (Glenmark Pharmaceuticals): £49.40
A box of 30 Truvada tablets (branded drug) costs around £355 (excluding VAT).
As we can see from the above examples, prices for generic Truvada tablets vary significantly. One should expect to pay additional fees if generic Truvada is prescribed on a private prescription and dispensed in a community pharmacy.
Prices for supply drugs on private prescription vary between pharmacies; therefore, it would be reasonable to ask a few pharmacies about the cost of the drug. Generally, one would expect to pay additional 10%-20% of the cost of the drug when a private prescription is processed in a community pharmacy. With the cheapest generic Truvada standing at around £50 per 30-day supply, one would be expected to pay around £60 for a box of 30 tablets.
Truvada – common side effects
Truvada common side effect
The following side effects are listed as common side effects for either of emtricitabine or tenofovir:
- insomnia, abnormal dreams
- hyperglycaemia (high sugar levels), hypertriglyceridaemia (high levels of triglycerides – fats)
- rashes, skin itchiness
- skin discolouration (increased pigmentation)
- general pain, abdominal pain
- flatulence (excess of gas)
Truvada very common side effects:
- Low potassium levels
- dizziness, headaches
- diarrhoea, vomiting, nausea
- Physical weakness
Please refer to product information leaflet for more information on side effects.
What to do when Truvada dose is missed
Product information advices the patient to take the pill straight away if the medication is forgotten within 12 hours of normal taking time.
If more than 12 hours passed since the last dose, and a patient is closer to taking another dose, the missed pill should be omitted.
A patient who vomits within 1 hour of taking the pill should take another dose.
Truvada: alternative options
Both active ingredients are available as separate drugs/tablets in generic and branded forms. For example, tenofovir disoproxil exists as a generic drug or branded as Viread tablets. Emtricitabine is available as a branded drug called Emtriva). This therapy would cost much more than treatment with a generic Truvada. The supply of both drugs as separate tablets would be, however, much more expensive than the use of a combination tablet.
NICE (2016). Pre-exposure prophylaxis of HIV in adults at high risk: Truvada (emtricitabine/tenofovir disoproxil). Available at: https://www.nice.org.uk/advice/esnm78/chapter/full-evidence-summary Accessed on 10/10/2020
PHE, Public Health England (2019). Prevalence of HIV infection in the UK in 2018. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/843766/hpr3919_hiv18.pdf Accessed on 10/10/2020