Who Should Get PrEP? Preventing HIV with a Pill

PrEPThe current recommendations for PrEP (pre-exposure prophylaxis) or prevention of HIV infection in people who are HIV negative are as follows:

  1.  It should be targeted to people at very high risk for HIV infection.
  2. PrEP should be taken daily for it to be effective.
  3. Women who are pregnant or trying to conceive should discuss the risks vs. benefits of PrEP with their doctor.
  4. PrEP should be part of a comprehensive pack of prevention services that include regular HIV testing, risk reduction, adherence counseling, and testing and treatment of sexually transmitted infections .
  5. PrEP should only be prescribed for people who are HIV negative.  Why is this?  Because PrEP uses only one or two HIV medications to prevent infection, and HIV treatment requires three medications.  We would never treat someone with HIV with only one or two HIV medications.

Do you know of a program to help people get Truvada for PrEP?  In Minneapolis, there is a program at Red Door Services for men enrolled in the HIM program, but it is a small pilot program.  Does your community have a similar program to access PrEP?

Tomorrow we’ll look at some exciting studies looking at better ways to give PrEP in the real world.





Capri Theatre to Host World AIDS Day Event with LaMont Wheat and Jamar Rogers November 30th


The Capri Theatre in Minneapolis will be the site of two coördinated programs designed to educate and entertain on Friday, November 30th.  The first event, The Brother Circle Dinner takes place 4-6 pm, and includes free food and discussion with Jamar Rogers, semifinalist on “The Voice” and LaMont Wheat, songwriter and performer of “Still Standing.”

The Sarah Simmons Showcase will take place from 6-8 pm at the Capri.  This event is a community talent show.  It will also features songs by special guests, Jamar and LaMont.  If you would also like to perform in the Showcase, please register by November 15th with Peggy Darrett-Brewer at 651-201-4138 or email peggy.darrett-brewer@state.mn.us.

Both events will include free information on HIV prevention, free condoms, free STD testing, and free door prizes.

It is going to be a fantastic evening, and the culmination of ten months of work by me with The Black AIDS Institute, African American HIV University and our own Black HIV Coalition.  It has been an honor to work with  inspiring people in Minneapolis and around the country to reduce HIV in Blacks.  Blacks are the most impacted group by HIV of any race or ethnic group in the United States.  Black gay and bisexual men are particularly hard hit by HIV.

 Built in 1927, the Capri Theater’s storied history includes 35 years as the Paradise Theater (from 1933 to 1967), as well as the place where Prince launched his international music career in January 1979. Located at 2027 West Broadway (one block east of Penn Ave. North), the Capri Theater is owned and operated by Plymouth Christian Youth Center (PCYC).  (Capri Website)

So join us for this fun evening of food, music, entertainment, and education.  Be part of the cure.  Let us end HIV in our lifetimes.



How to Survive and Thrive with HIV

The Red ribbon is a symbol for solidarity with...

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Living with HIV is a challenge, but medications for HIV are truly life-saving.   I should know, because these medications saved MY life.  As a pharmacist for thirty years, I have been around the block a couple of times.   For the last ten years, I have helped hundreds of people to be successful with HIV medications at  clinics in Minneapolis and St. Louis Park in Minnesota.  I provide individual consultations for HIV medication adherence through a Federal grant program.What is medication adherence?  It is helping people take their medications correctly every day so they have great results.I am often asked by people unfamiliar with HIV or people just starting treatment,  “What’s so hard about taking a pill every day?”Taking medication daily DOES have its challenges.  I’ll be exploring these challenges, and ways to overcome them in this blog.  I’m also developing a website at williamlarsonpharmd.com and a FaceBook Page, and videos are soon to come!
I look forward to hearing from you and getting your comments and feedback.
Wishing you a great day!

CROI: HIV Meds Prevent HIV Transmission in Condomless Sex for Gay & Straight

There was exciting news out of CROI (Conference on Retroviruses and Opportunisitic Infections) yesterday on HIV medication preventing HIV transmission to negative partners. http://www.aidsmap.com/page/2832748/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English

If you are on HIV medication for your HIV and your viral load is under 200 copies, there is very little chance of transmitting the virus even without a condom. Acheiving a viral load under 200 copies is relatively easy if you are able to adhere to therapy and take it daily.

According to this report, the maximum likely chance of transmission via anal sex from someone on successful HIV treatment was 1% a year for any anal sex and 4% for anal sex with ejaculation where the HIV-negative partner was receptive. The researchers went on to say that the true likelihood is probably much nearer to zero than this.

This is additional evidence that taking HIV medications prevent transmission. Condoms, though still recommended as a way to prevent HIV and sexually trasmitted infections, are often unpopular or ignored. I work with serodiscordant couples, gay and straight, who ask me if they can safely have sex without a condom as long as the HIV positive person is virally suppressed. Here is more information that the answer is “yes!”

What are your thoughts? Would you be comfortable skipping the condom if your HIV positive partner is non-detectable? Are you doing this now?

Have a great day!


Tivicay (dolutegravir): New Integrase Inhibitor for Treatment of HIV

Tivicay (dolutegravir) is a new integrase inhibitor recently approved in the US for threatment of HIV in combination with other antiretroviral agents.  It can be used in adults and children aged 12 years and older who weigh at least 40 kg.

For most people, the dosage is one 50 mg tablet of Tivicay once a day, with or without food.  This would include people who have never taken HIV medication before, known as treatment-naive, and people who have never taken an integrase inhibitor previously.

Some people should take a higher dose of Tivicay, 50 mg twice a day.  If you also take efavirenz (Sustiva, Atripla), fosamprenavir/ritonavir (Lexiva/Norvir), tipranavir/ritonavir (Aptiva/Norvir), or rifampin, you should take the higher dosage due to a drug interaction.

You should also take a higher dose of Tivicay, 50 mg twice a day, if you were on an integrase inhibitor previously (raltegravir (Isentress) or elvitegravir (Stribild) and your virus developed some specific viral mutations.

We are expecting a single tablet regimen to be approved by the FDA later this year.  This new single tablet regimen would be a complete HIV regimen for most people with HIV, and would contain Tivicay and Epzicom in a single pill.

In my next blog, I’ll look at the effectiveness of Tivicay.   I am really excited about this new treatment option!

Have a great day!





Insurance Coverage of Lipodystrophy Treatments Reduces HIV Stigma

Today’s PA Weekly 2/24/14 reports on a story from Massachusetts in which a hearing will be conducted to urge insurers to cover lipodystrophy treatment from HIV.  Lipodystrophy can take many forms, but usually results in fat loss in the limbs and face and fat deposits in the neck and belly.  Treatments of lipodystrophy include facial fillers, such as Sculptra and Radiesse, and Egrifta for belly fat.  The treatments reduce the appearance of lipodystrophy, but are not permanent.  In addition, the manufacturer of Egrifta recently announced that it is stopping production of Egrifta for an unspecified time due to a production problem.


Should lipodystrophy be a covered benefit?  Some people say no, because they consider the treatment as cosmetic and medically unnecessary.  The article goes on to state that lipodystrophy may have severe physical and psychosocial consequences. “Fat accumulations on the neck can cause pain, headaches, restricted movement, inability to sleep, and spinal and postural problems.”
Supporters of insurance coverage for lipodystrophy say that it results in “impaired quality of life in both men and women with HIV,” including depression, isolation, poor social functioning, and increased stigma associated with HIV.”  The stigmatizing impact of lipodystrophy has also caused patients to discontinue their HIV medications, which can result in a further decline in their immune system, viral resistance, and increased likelihood of transmitting the virus to partners.

I understand the devastating effect of lipodystrophy first hand.  It’s how people with HIV can identify each other with a glance-especially the loss of facial fat, which is characteristic in men and women who have lived with the virus for years.

I experienced lipodystrophy stigma years ago in a bar in Dallas.  Already feeling self-conscious about being from out-of-town and alone, I noticed that no one approached me to say hello.  Finally, a guy came over to talk and told me I could seek treatment for my loss of facial fat.  I think he was trying to be helpful, but it had the opposite effect.  I felt like a leper, and at that point, the evening was over for me and I went home depressed.  It was then that I vowed to get facial filler for my face.  Fortunately, I can afford it, but I have clients who cannot afford it, and insurance does not pay for it.

Lipodystrophy from HIV should be a covered benefit in Massachusetts and everywhere else.  People do not want to survive HIV only to face HIV stigma for the rest of their life due to their appearance.  Covering lipodystrophy treatment will encourage people with HIV stay on their medications and have a result in better physical and mental health and less HIV stigma.


BMS Co-Pay Assist Program Update

BMS Copay Card uprightToday I’ll review the BMS Co-Pay Assist Program which will save you money on Atripla, Reyataz, and Sustiva copays. In fact, the BMS program covers up to the first $400 per monthly co-pay for a year for each of these three medications. Sweet!

Copay cards can reduce or eliminate your monthly co-pays for HIV medication. Please note that they do not work if you are on Medicare, Medicaid, Medigap, VA, DOD, or TriCare.

You can get a BMS Co-Pay Assist Program card from your HIV provider or HIV specialty pharmacy, or you can enroll by phone.  Here’s the link to learn more:  http://www.bms3assist.com/copay/

If you use mail order, check with your mail order pharmacy to see if they accept the cards. If they do not, you can pay for it, save your receipts, and send them to BMS for reimbursement.

What has been your experience, good or bad, using these card programs?

Gilead Co-Pay Assistance Program: Save Big Money

It’s the first quarter of the year, and you have big deductibles and co-pays for your HIV medications.  It there anything you can do? 

The answer is yes, you should check into co-pay cards.  These programs can reduce or eliminate your monthly co-pays for HIV medication.  Please note that they do not work if you are on Medicare, Medicaid, Medigap, VA, DOD, or TriCare.

Most programs require enrollment and you must do this before your pick up and pay for your prescription.  The cards are not retroactive.

If you use mail order, check with with your mail order pharmacy to see if they accept the cards.  If they do not, you can pay for it, save your receipts,and send them to Gilead for reimbursement.

Today I’ll focus on our most used copay card, Gilead’s Co-Pay Assistance Program.


It will save you $200 month on Truvada, Viread, and Emtriva and $400 per month on Stribild, Complera, and Atripla.  Why pay a copay if you don’t have to?

You can ask your provider or pharmacist for a card.  If they do not have one or they look at you blankly, call 1-877-505-6986 to enroll. You can also enroll online at www.GileadCoPay.com.  

What has been your experience, good or bad, using these card programs?


HIV 101: Making Sense of the Acronyms

If you are new to HIV, you have probably noticed that doctors and pharmacists throw around alot of initials, abbreviations, and acroynms.  Let’s take a closer look:

HIV:  Human Immunodeficiency Syndrome

AIDS:  Acquired Immune Deficiency Syndrome

ART:  Antiretroviral therapy

HAART:  Highly Active Antiretroviral Therapy

ART and HAART are the same thing.  In the old days, we called it the “cocktail,” or a combination of medications to treat HIV.

HIV pharmacy is an exciting field, because new advances occur all the time.  Newer HIV medications are simpler, have fewer side effects, and require fewer pills.  In spite of these advances, adherence, or the ability to take the medication daily, is a common reason people fail on their HIV drug therapy.

Twenty-five percent of patients will fail HI drug therapy in the first year, and about 25% will have to change their HIV drug regimen within the first year due to drug-related adverse events.  As I tell my clients, there are now many options for treating HIV, so if you are new to HIV treatment, you will have many great options.



PrEP: Preventing HIV with Truvada

This week I’m reviewing work underway at the Health Prevention Trials Network (HPTN) on PrEP, or pre-exposure prophylaxis of HIV.  This is giving HIV medication to people who are negative who are at high risk of  becoming infected.

If you are wondering why it’s not just for whores, watch this video:

So Truvada is for anybody who might have an occasional slip up or regular slip ups in terms of using a condom during sex.  One of the concerns about PrEP is that it could be challenging to take daily, as currently recommended.  Would it work if you took it less frequently?  That is a question waiting for an answer.

The HPTN 067  or ADAPT Study is going to help answer that question.  ADAPT stands for “Alternative Dosing to Augment PrEP pill-Taking”.  Clever name, don’t you think?

This study will examine what is the most effective way to take PrEP.  One third of the participants will take Truvada daily, 1/3 will take it just before and after sex, and the final 1/3 will take it two times a week and a booster after sex.

Participants should take no more than 2 tablets in a 24-hour period or seven  tablets in a week.

This study will enroll men who have sex with men (MSM) and women.

If intermittent PrEP works as well or better than daily PrEP, this would make PrEP more acceptable, easier to use, possibly safer, and less expensive.

The ADAPT study is taking place in Cape Town, South Africa, Bangkok, Thailand, and New York, US.

What about other medications besides Truvada for PrEP?  Tomorrow we’ll look at a study that is looking at maraviroc for PrEP.

Are you taking PrEP?  Are you enrolled in a trial, getting it through your doctor’s office, or somewhere else?


Study Will Answer Question: Will Black Gay/Bisexual Men Take a Pill to Prevent HIV

Black menHPTN 073 is examining PrEP in Black men who have sex with men (BMSM).  Why BMSM?  Because BMSM account for 28% of all new HIV infections in the US, while representing less than 1% of the population.

HPTN 073 is a demonstration project of Truvada combined with comprehensive clinical care coordination in 225 participants in 3 US sites, Washington, DC, Chapel Hill, NC, and Los Angeles, CA.

The questions to be answered by HPTN 073 are:

  1.  Will Black MSM use PrEP?
  2. Is PrEP safe for Black MSM?
  3. Does it work to combine client-centered care coordination along with PrEP to BMSM.

Client centered care coordination is defined as follows:   “This is an approach in which each client’s unique biological social and interpersonal realities are taken into consideration with the goal of optimizing retention and adherence.”

That seems like a bunch of gobbledygook to me, but as I read further, I learned that  it is really just bringing various healthcare workers, such as social workers, case managers, pharmacists, and nurses, together to figure out what the client needs to be successful to improve their health and reduce barriers to their care.  Barriers to care would include poverty, homelessness, substance use, mental illness, and incarceration.

Not enough has been done to study PrEP in Black MSM, so this is an exciting study which will help us understand how to best use PrEP for this group.

If you are a Black male who has sex with men, would you enroll in this study?

PrEP Results Showed No Effect in Women in Two Studies in Africa


Yesterday I reviewed evidence that PrEP actually works to prevent HIV infection in people who are negative.  

Today I am reviewing studies that did not show that PrEP works. 

The first is FEM-PrEP, a study of 2120 women in Kenya, South Africa and Tanzania.  These women were not enrolled in the study as part of a couple.  It compared Truvada  (tenofovir/emtricitabine) to placebo, and Truvada was found ineffective in preventing HIV due to low adherence, only about 33%.

The second disappointing study was MTN-003 (VOICE), which looked at 5,029 women in South Africa, Uganda, and Zimbabwe.  It compared tenofovir (Viread ) vs. placebo, Truvada to placebo, and tenofovir vaginal gel vs. placebo.  No product proved effective in preventing HIV due to low adherence, estimated at only 23-29%.

Why did these studies show that the active drug was ineffective in preventing HIV infection, when the studies I discussed yesterday found that PrEP works?  The main reason was lower adherence.  In the FEM-PrEP and Voice studies, the women were not taking enough medication to get any effect from it.

Why didn’t the women adherence better to the PrEP?  Although we do not know, some of the reasons might be cultural, mistrust of the medication, or believing they were not at risk for HIV infection.

Tomorrow we’ll look at the current recommendations for who should receive PrEP.