Dr. Claus (Medical Director of the YOU Center for Wellness at Erie County Medical Center) talks about PrEP for HIV Prevention. Dr. Claus explains what is PrEP, how it works, and the medication options.
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PrEP for HIV Prevention
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Jonathan A. Claus, MD
Jonathan Claus, MD, is a dual board-certified infectious disease and internal medicine physician at Erie County Medical Center (ECMC). With expertise in Immunodeficiency and Infectious Disease services, Dr. Claus serves as the Medical Director of the YOU Center for Wellness focusing on diagnosing and treating a broad spectrum of general infectious diseases. In this role he provides direct care in both inpatient and outpatient settings, oversees quality care initiatives and supervises advanced practice providers.Learn more about Jonathan Claus, MD
Learn more about the YOU Center
Transcription:
Prakash Chandran: Did you know that there's a medicine that can help prevent getting HIV? It's called PrEP. And when used properly, it can lower your chances of getting the disease by over 90%. We're going to talk about it today with Dr. Jonathan A. Claus, Medical Director of the Youth Center for Wellness at Erie County Medical Center.
This is the True Care Health podcast, the official podcast from Erie County Medical Center. I'm your host, Prakash Chandran. So Dr. Claus, thank you so much for taking the time today. I really appreciate it. We're talking about PrEP today. Tell us what that is and how it works.
Jonathan A. Claus, MD: Hi, Prakash. Thank you for having me. Well, PrEP is actually right in the name. It's spelled P-R-E-P. And so, the P stands for pre, so preexposure. And the last P is for prophylaxis, which means prevention. And so, it prevents you from getting HIV before the infection might take place. And since there is no other way really to prevent it other than condom use, this medication helps us keep our patients healthy.
Prakash Chandran: Okay. That makes a lot of sense. Now, is PrEP one medication? Is it a series of medications? Can you talk a little bit about that?
Jonathan A. Claus, MD: Absolutely. There are three approved medications for PrEP. Two of them are tablets, a pill that you take once a day or an injection that you get every two months. The two pills you might have heard about in social media or on TV. They are Truvada and Descovy, and the new medication that's injectable is called Apretude.
Prakash Chandran: Okay. And tell me how effective is PrEP at preventing HIV?
Jonathan A. Claus, MD: That's a very good question. It is 99% effective in the studies that were conducted to approve the three medications, which is pretty exciting to have a medication that effective.
Prakash Chandran: That is absolutely incredible. And that 99% effectiveness, that is when used or the medication is taken in the correct way. Is that right?
Jonathan A. Claus, MD: Yes. And so, we have you take a tablet once a day, every day. And after about seven days in some patients and three weeks in others, you are fully protected from the medication as it kind of equilibrates in your system. And then, just to keep you safe, we perform routine testing every three months, just to make sure that you are free of HIV and are tolerating the medication.
Prakash Chandran: Yeah. So, let's talk a little bit about that. I know a question that frequently comes up is, is PrEP safe? So, talk a little bit about that three-week period, any side effects that people might experience and how patients can actually establish if it's right for them?
Jonathan A. Claus, MD: The medications are very safe. They have minimal side effects. And whether you take a sugar pill, placebo, or a blood pressure medication, most of the side effects are managed and usually are gone after four weeks of starting the medication. They usually include nausea, a little bit of vomiting, some diarrhea, mild headache, nothing very earth-shattering and the side effects are minimal.
Some people have heard about kidney problems with Truvada. And so, that's why there is a newer formulation, the Descovy. One of the medications in these two tablets is called tenofovir and has a potential to harm your kidneys, you know, sort of a one in a million kind of thing. And so, the newer medication, that's the injectable medication, Apretude, does not contain that medication and that's why it's such an exciting new revolution that it works just as well and doesn't have any of those sort of potential kidney or bone side effects. And as an injection, you also don't have to forget to take a pill. You just come to the office every two months.
Prakash Chandran: Okay. So, it's not a daily pill. It is an injectable that you visit, you know, once every two months, and then you're protected in the same way.
Jonathan A. Claus, MD: Exactly. And you can kind of do two birds, one stone. When you come to your appointment, you can get your blood work done and your lab slip and get your shot and then come back in two months and just see the nurse. You see a provider or me as a physician just to see how you're doing and have an in-person visit every three to six months, just to make sure you are tolerating the medication and feel like you're doing okay on it.
Most people that have those physical side effects where they feel nauseated or having some diarrhea, that goes away. And then, for the side effects, you know, all medications can potentially harm your liver, your kidneys. We check that lab work very closely every three to six months, just to make sure that something's not brewing.
Prakash Chandran: So, we know that PrEP is really sound at preventing HIV. Does it prevent against any other STI?
Jonathan A. Claus, MD: That's also a very good question and it does not, unfortunately. And so when you come to your appointments, we have plenty of condoms that we hand out. We try to educate patients on using them. And if you have any other STD or STI that pops up, say you have symptoms or you don't and suddenly found yourself with gonorrhea or something like that, we will treat you in our clinic. So, it's not a panacea for everything and you must use a condom for those other STIs, like say herpes, which there is no real prevention for and is sort of a forever type infection. So, we not only test you for all of those potential exposures in other STI, but we also treat them if they pop up.
Prakash Chandran: Let's say you start PrEP. Once you start, how often do you need to come in and get tested at the office?
Jonathan A. Claus, MD: Well, when you start one of the oral medications, say Truvada, you would come here every three months and be seen by a provider, have a physical exam and get your testing done same day in the clinic.
Prakash Chandran: Okay. So, every three months. And I know you said for the injectable, it's every two months. Does that like cadence somehow change if you're getting the injectable versus the pill?
Jonathan A. Claus, MD: The injectable is given every two months as a nursing visit, you don't necessarily need to see a provider. You just come in and get it, like you're getting a flu shot and then leave. And you can still be seen by us physically every three months. We're hoping that this medication can keep evolving and eventually it will be approved for every three months.
Prakash Chandran: Okay. And I just have, I guess, a broader question, who should be considering getting PrEP? And is there anyone that shouldn't get it?
Jonathan A. Claus, MD: There are patients that are interested in it and we discuss the risks and benefits and they decide that it's something they would like to try. And it's not something you have to take forever. And so, if you feel like you have side effects that are intolerable, or you don't want it, we can easily stop it. The New York State Department of Health says that anybody that is interested and would like to take PrEP is able to take it. There is no sort of exclusion criteria. If you have any concern about who you're having sex with, it's right for you. People who abuse drugs intravenously, we also give this medication too, because they're at risk for getting HIV and it helps give people a peace of mind.
Prakash Chandran: Yeah, absolutely. And I guess this leads to my next question. Is there medical coverage assistance if a patient does not have insurance?
Jonathan A. Claus, MD: All of these medications are expensive, whether you have insurance or not. We do all of the paperwork and all the prior authorization requests, so you don't have to worry about that. We have a support staff with pharmacists right in our clinic to help you with all of your questions. We make sure that these medications do not interact with any of the other medications you might be on, make sure it's safe. And all of these medications, all three of them are covered by Medicaid and most commercial insurances. If you don't have insurance, we will help you get it. And all of them have drug assistance programs. Say, for whatever reason, we can't get you insurance and you can't afford it, usually the drug company kind of covers you for it because we want to keep people as healthy as possible and it's sort of an ounce of prevention versus a pound of cure.
Prakash Chandran: Yeah, that totally makes sense. So just before we close here today, is there anything else that you wanted to share with our audience, just about PrEP or general HIV prevention?
Jonathan A. Claus, MD: We're trying to get the word out about PrEP. And with this new injectable medication, it's one less thing that you have to worry about getting in this prevention medication and you don't even have to worry about taking a pill. So if you have any questions about it, you want to talk it over, you absolutely can. And you can call our clinic at (716) 898-4119 and speak to me, speak to a nurse, speak to our pharmacist, and we can talk you through and decide if this medication is right for you.
Prakash Chandran: Well, Dr. Claus, thank you so much for your time. I really appreciate it.
Jonathan A. Claus, MD: Thank you so much, Prakash. I had a a great time.
Prakash Chandran: That was Dr. Jonathan A. Claus, Medical Director of the Youth Center for Wellness at Erie County Medical Center. For more information, you can visit ecmc.edu or you can call the clinic directly at (716) 898-4119. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been another episode of the True Care Health Podcast. My name's Prakash Chandran. Thanks so much for listening and be well.
Prakash Chandran: Did you know that there's a medicine that can help prevent getting HIV? It's called PrEP. And when used properly, it can lower your chances of getting the disease by over 90%. We're going to talk about it today with Dr. Jonathan A. Claus, Medical Director of the Youth Center for Wellness at Erie County Medical Center.
This is the True Care Health podcast, the official podcast from Erie County Medical Center. I'm your host, Prakash Chandran. So Dr. Claus, thank you so much for taking the time today. I really appreciate it. We're talking about PrEP today. Tell us what that is and how it works.
Jonathan A. Claus, MD: Hi, Prakash. Thank you for having me. Well, PrEP is actually right in the name. It's spelled P-R-E-P. And so, the P stands for pre, so preexposure. And the last P is for prophylaxis, which means prevention. And so, it prevents you from getting HIV before the infection might take place. And since there is no other way really to prevent it other than condom use, this medication helps us keep our patients healthy.
Prakash Chandran: Okay. That makes a lot of sense. Now, is PrEP one medication? Is it a series of medications? Can you talk a little bit about that?
Jonathan A. Claus, MD: Absolutely. There are three approved medications for PrEP. Two of them are tablets, a pill that you take once a day or an injection that you get every two months. The two pills you might have heard about in social media or on TV. They are Truvada and Descovy, and the new medication that's injectable is called Apretude.
Prakash Chandran: Okay. And tell me how effective is PrEP at preventing HIV?
Jonathan A. Claus, MD: That's a very good question. It is 99% effective in the studies that were conducted to approve the three medications, which is pretty exciting to have a medication that effective.
Prakash Chandran: That is absolutely incredible. And that 99% effectiveness, that is when used or the medication is taken in the correct way. Is that right?
Jonathan A. Claus, MD: Yes. And so, we have you take a tablet once a day, every day. And after about seven days in some patients and three weeks in others, you are fully protected from the medication as it kind of equilibrates in your system. And then, just to keep you safe, we perform routine testing every three months, just to make sure that you are free of HIV and are tolerating the medication.
Prakash Chandran: Yeah. So, let's talk a little bit about that. I know a question that frequently comes up is, is PrEP safe? So, talk a little bit about that three-week period, any side effects that people might experience and how patients can actually establish if it's right for them?
Jonathan A. Claus, MD: The medications are very safe. They have minimal side effects. And whether you take a sugar pill, placebo, or a blood pressure medication, most of the side effects are managed and usually are gone after four weeks of starting the medication. They usually include nausea, a little bit of vomiting, some diarrhea, mild headache, nothing very earth-shattering and the side effects are minimal.
Some people have heard about kidney problems with Truvada. And so, that's why there is a newer formulation, the Descovy. One of the medications in these two tablets is called tenofovir and has a potential to harm your kidneys, you know, sort of a one in a million kind of thing. And so, the newer medication, that's the injectable medication, Apretude, does not contain that medication and that's why it's such an exciting new revolution that it works just as well and doesn't have any of those sort of potential kidney or bone side effects. And as an injection, you also don't have to forget to take a pill. You just come to the office every two months.
Prakash Chandran: Okay. So, it's not a daily pill. It is an injectable that you visit, you know, once every two months, and then you're protected in the same way.
Jonathan A. Claus, MD: Exactly. And you can kind of do two birds, one stone. When you come to your appointment, you can get your blood work done and your lab slip and get your shot and then come back in two months and just see the nurse. You see a provider or me as a physician just to see how you're doing and have an in-person visit every three to six months, just to make sure you are tolerating the medication and feel like you're doing okay on it.
Most people that have those physical side effects where they feel nauseated or having some diarrhea, that goes away. And then, for the side effects, you know, all medications can potentially harm your liver, your kidneys. We check that lab work very closely every three to six months, just to make sure that something's not brewing.
Prakash Chandran: So, we know that PrEP is really sound at preventing HIV. Does it prevent against any other STI?
Jonathan A. Claus, MD: That's also a very good question and it does not, unfortunately. And so when you come to your appointments, we have plenty of condoms that we hand out. We try to educate patients on using them. And if you have any other STD or STI that pops up, say you have symptoms or you don't and suddenly found yourself with gonorrhea or something like that, we will treat you in our clinic. So, it's not a panacea for everything and you must use a condom for those other STIs, like say herpes, which there is no real prevention for and is sort of a forever type infection. So, we not only test you for all of those potential exposures in other STI, but we also treat them if they pop up.
Prakash Chandran: Let's say you start PrEP. Once you start, how often do you need to come in and get tested at the office?
Jonathan A. Claus, MD: Well, when you start one of the oral medications, say Truvada, you would come here every three months and be seen by a provider, have a physical exam and get your testing done same day in the clinic.
Prakash Chandran: Okay. So, every three months. And I know you said for the injectable, it's every two months. Does that like cadence somehow change if you're getting the injectable versus the pill?
Jonathan A. Claus, MD: The injectable is given every two months as a nursing visit, you don't necessarily need to see a provider. You just come in and get it, like you're getting a flu shot and then leave. And you can still be seen by us physically every three months. We're hoping that this medication can keep evolving and eventually it will be approved for every three months.
Prakash Chandran: Okay. And I just have, I guess, a broader question, who should be considering getting PrEP? And is there anyone that shouldn't get it?
Jonathan A. Claus, MD: There are patients that are interested in it and we discuss the risks and benefits and they decide that it's something they would like to try. And it's not something you have to take forever. And so, if you feel like you have side effects that are intolerable, or you don't want it, we can easily stop it. The New York State Department of Health says that anybody that is interested and would like to take PrEP is able to take it. There is no sort of exclusion criteria. If you have any concern about who you're having sex with, it's right for you. People who abuse drugs intravenously, we also give this medication too, because they're at risk for getting HIV and it helps give people a peace of mind.
Prakash Chandran: Yeah, absolutely. And I guess this leads to my next question. Is there medical coverage assistance if a patient does not have insurance?
Jonathan A. Claus, MD: All of these medications are expensive, whether you have insurance or not. We do all of the paperwork and all the prior authorization requests, so you don't have to worry about that. We have a support staff with pharmacists right in our clinic to help you with all of your questions. We make sure that these medications do not interact with any of the other medications you might be on, make sure it's safe. And all of these medications, all three of them are covered by Medicaid and most commercial insurances. If you don't have insurance, we will help you get it. And all of them have drug assistance programs. Say, for whatever reason, we can't get you insurance and you can't afford it, usually the drug company kind of covers you for it because we want to keep people as healthy as possible and it's sort of an ounce of prevention versus a pound of cure.
Prakash Chandran: Yeah, that totally makes sense. So just before we close here today, is there anything else that you wanted to share with our audience, just about PrEP or general HIV prevention?
Jonathan A. Claus, MD: We're trying to get the word out about PrEP. And with this new injectable medication, it's one less thing that you have to worry about getting in this prevention medication and you don't even have to worry about taking a pill. So if you have any questions about it, you want to talk it over, you absolutely can. And you can call our clinic at (716) 898-4119 and speak to me, speak to a nurse, speak to our pharmacist, and we can talk you through and decide if this medication is right for you.
Prakash Chandran: Well, Dr. Claus, thank you so much for your time. I really appreciate it.
Jonathan A. Claus, MD: Thank you so much, Prakash. I had a a great time.
Prakash Chandran: That was Dr. Jonathan A. Claus, Medical Director of the Youth Center for Wellness at Erie County Medical Center. For more information, you can visit ecmc.edu or you can call the clinic directly at (716) 898-4119. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been another episode of the True Care Health Podcast. My name's Prakash Chandran. Thanks so much for listening and be well.