Demystifying PrEP for Clinicians

Segment Description: Paul Sax, MD, clinical director, professor of medicine, Harvard Medical School; clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital, explains how he would demystify PrEP to clinicians who are not comfortable using HIV medications.

Interview transcript (modified slightly for readability):

Contagion®: How would you address a clinician who is not recommending PrEP to patients that are at a higher risk for HIV?

Paul Sax, MD: One problem with PrEP is that the providers, the clinicians who are really responsible for initiating it are often the people who are not comfortable using HIV medications. We need some education and part of that would be to say ‘look, this is actually quite simple.’ When you identify a person who's at substantial risk of acquiring HIV, having them take 1 pill a day of emtricitabine-tenofovir disoproxil fumarate or Truvada, is really safe and effective and you should go for it.

Some people are also worried by the extremely strict monitoring requirement of people on PrEP. I think those should be considered a best-in-class or best-case scenario. We shouldn’t over-medicalize the whole process though, so if a person can’t necessarily commit to the intensive every 3-month monitoring, we shouldn’t then say they aren’t a good candidate for PrEp — they still could be a good candidate.

I would try to de-mystify it by saying ‘look, it’s really simple.’ It’s actually much simpler than for example, treating high blood pressure or diabetes.”