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HIV Prevention with PrEP Medications: Key Facts and Benefits [Podcast]

Posted October 02, 2023

Listen to this episode of the Healthy Vitals Podcast.

Join us as we explore PrEP (Pre-Exposure Prophylaxis), a powerful tool in preventing HIV infection. We'll cover its definition and remarkable effectiveness in reducing the risk of HIV transmission.


Featured Guests:

John Tomich, M.D
John Tomich graduated from Northeast Ohio Medical University and completed a residency in Family medicine at St. Elizabeth Youngstown Hospital in Youngstown, OH. He works as a clinical physician at the Center for AIDS Research and Education (CARE Center) where he focuses on the treatment and prevention of HIV. 


Amy Hite, M.D

Amy Hite received her medical degree from Northeast Ohio Medical University. She completed her Internal Medicine residency at Summa Health System and is a certified HIV Specialist from the American Academy of HIV Medicine. She is the current Director of Summa Health System’s Center for AIDS Research and Education, where she has worked for the last 20 years, caring for HIV and PrEP patients.

Transcription:

Scott Webb (Host): You may have seen some commercials for medications called PrEP, Pre-Exposure Prophylaxis, and wondered what exactly these drugs are for. Well, you came to the right place by listening to the podcast today because I'm joined by doctors Amy Hite and John Tomich. They're both Summa Health Medical Group physicians at the Care Center, and they're here today to tell us what PrEP is, who it's appropriate for, and how patients can access PrEP at Summa Health.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb.

Want to thank you both for joining me today. We're going to talk about HIV prevention and PrEP and what all that means and how folks can get access to it and all that good stuff. So, Dr. Tomich, I'll start with you. What is PrEP and how effective is it at preventing HIV infection?

 

What is PrEP?

 

John Tomich, M.D.: So PrEP, which stands for pre-exposure prophylaxis is one to two medications that are used both for the treatment of HIV, but in this specific situation, they're used to be taken prophylactically to prevent those at risk of contracting HIV from acquiring it; whether that be through sexual transmission or through IV drug use.


Scott Webb (Host): And Doctor, how effective is PrEP?

 

How effective is PrEP?

 

John Tomich, M.D.: To be most effective, it does need to be taken consistently to ensure that there are adequate drug levels in the system to ensure there's adequate protection and levels of drug to prevent transmission. When taken consistently, it's proven to be 90% or more effective at preventing transmission when the risk factors are sexual in nature and in terms of IV drug use and those that share needles, it's greater than 70% effective at preventing transmission of HIV.


Host: Yeah, it's really amazing. I'm about to turn 55, and so I've sort of lived through this, all of this with HIV and AIDS, and it's just really amazing how far it's come and how effective PrEP is. So Dr. Hite then, what are the medications for PrEP and how are they administered?

 

What are the medications for PrEP and how are they administered?


Amy Hite, M.D: So there are currently three FDA approved medications for PrEP that are available. There are two oral medications and one injectable medication. The two oral medications are Truvada and Descovy. Truvada was the first medication that was approved for PrEP all the way back in 2012. It is a medication that's taken orally.

It's a combination of two different HIV medications that are together in one pill. It's typically taken daily and it's approved for all at-risk populations and genders. The next oral medication is Descovy, which came out a few years ago in an indication for PrEP. It is also an oral medication. Again, a combination of two different HIV medications, very similar to the ones that in Truvada, but these are slightly different and have less potential effects on the bones and kidneys long-term compared to Truvada.

It's usually taken again daily. The difference of Descovy and Truvada in addition to the renal and bone risk is that Descovy has only been studied in patients that were assigned male at birth, so it's only approved for those patients at this time. There are studies, however, that are looking at it for those who are assigned female at birth with regards to PrEP. And then the final medication that is approved for PrEP is a long-acting injectable medication that's goes by the name of Apretude.

It is in a different class of medications than Truvada and Descovy. It's typically given by an intramuscular injection. So you have to get that at the doctor's office every eight weeks. And when done on schedule, it's proven to actually be superior to oral PrEP, most likely, because patients don't have to remember to take a pill every day.


Host: Sure. So Dr. Tomich, you talked about those at the greatest risk, but let's talk a little bit more just specifically about the patients you know, who should really think about starting PrEP?

 

Who should be taking PrEP?

 

John Tomich, M.D.: Identifying the right patients for PrEP is an important part of the process. In this country, a lot of times, gay bisexual men and other men who have sex with men are at an increased risk for acquiring HIV. So those are definitely at risk group to screen for PrEP and potentially initiate PrEP.

Also, those that have multiple sexual partners, those that have inconsistent condom usage with their partners. Anybody who has had a prior STI in the past, so having been treated for gonorrhea, chlamydia, or syphilis previously. Anybody who has a known partner with HIV or an HIV status unknown, especially if the partner with HIV is not linked into care and taking medicines consistently. Anybody who might be engaging in sex for either drugs or money, and then those individuals who use IV drugs, especially with known sharing of needles while they use.


Host: Yeah. And, Dr. Hite, maybe you could talk a little bit more about what patients can expect. You know, when they come for a visit for PrEP, when they begin to have these conversations, what can they expect?

 

What should patients expect when they visit for PrEP?


Amy Hite, M.D: Yeah, that's a good question because hopefully, some of those conversations are starting to happen maybe at just your routine healthcare appointments. That's what we would ideally like to see. But if you are talking either with your primary doctor about PrEP or if you've actually been referred to a different specialist for PrEP, there are some things that are going to happen pretty consistently at those visits, no matter where you're accessing your PrEP.

And a lot of those visits are going to be focusing on history and the sexual history, of course, is very important. Substance abuse history is very important because we're really trying to identify does this patient have significant risk factors for the acquisition of HIV. So a risk assessment is very important, and that risk assessment is pretty in depth sexual history and including history of prior sexually transmitted infections and those sorts of things.

Then of course you're going to have a physical exam, and that physical exam is going to include, certain types of appropriate sexually transmitted infection tests or swabs a lot of times, depending what areas need to be evaluated for STDs. And then we need to do some additional labs, and those are going to be blood work typically to determine HIV status, evaluating somebody's baseline kidney function, looking at some other STDs, screening for different types of hepatitis and those types of things.

It's very important to know a person's status before they start PrEP so we definitely have to screen everybody consistently for HIV, not only at that very first PrEP appointment, but then really at every PrEP appointment moving forward. So what typically happens in follow up visits then, is that a patient would have HIV testing done every three months if they're on oral PrEP, because patients will come in every three months for assessments and evaluations, and then because the injections are done every two months, then a patient who's on Apretude for PrEP would have to get HIV testing done for those appointments every two months.


Host: Yeah, it's good to take folks through that, obviously, you know, initially especially examination, full patient history, lots of honesty and transparency, and then some work to be done along the way as well. Dr. Tomich is PrEP, the kind of thing where folks can just kind of get it anywhere. Maybe you can take us through that, where the places and providers, where potential patients, folks at risk have been thinking about it, where they can find PrEP.

 

How can patients get on PrEP?



John Tomich, M.D.
: So there's a couple different avenues that a patient can get on PrEP or get pointed in the right direction of who to get PrEP from. A lot of primary care offices, so the outpatient family medicine clinics, private doctors, internal medicine centers, would be able to prescribe if they're comfortable or will be able to get a patient referred to somebody who is prescribing PrEP.

Likewise, some OBGYNs, for female patients can prescribe PrEP and do prescribe PrEP in their GYN clinics. Any HIV or other sexual health kind of clinics, community clinics are usually good places for patients to access PrEP. And then patients can also reach out to their county health board, health department and they either can usually prescribe PrEP there or again, know the appropriate channels of how to get a patient linked into a physician's office that is actively prescribing PrEP.


Host: Dr. Hite, we wrap up here, we think about Summa specifically, where can a patient access PrEP.

 

How can Summa Health patients access PrEP?


Amy Hite, M.D: Thanks for asking that because we want to get as many people who are at risk on PrEP as possible. When we look at statistics across the United States, there are many, many people who are eligible for PrEP who are not accessing PrEP. And so that's what we wanted to try to do here is make sure that people know about it, but then also know where can they go to access it. And a patient at Summa, can access PrEP in many different avenues, which is good. I think, like Dr. Tomich said, the good place to start with that is just talking to your primary care provider and whether that be, family medicine, internal medicine, just your local community doctor that you see, ask them, start a conversation about PrEP.

If they're not comfortable prescribing PrEP, then they can refer to a couple of different places at Summa. One of those is the Care Center, where Dr. Tomich and I practice. And the Care Center is a clinic that is focused on HIV treatment and prevention. The patients can be referred by their PCPs or they can call the Care Center directly at 330-375-4851. Summa also has a Pride Clinic, which is for patients that identify as LGBTQ+. And the providers there are knowledgeable about administering PrEP, and that's another great place to access it at Summa. Part of access to PrEP though too, is not just where you can go, but how can I get this medication?

Like, how can I get this medicine and all these labs that we talked about paid for. And so, that's another thing that many patients may have as a barrier to starting PrEP. Under the Affordable Care Act, PrEP medications and PrEP labs must be covered for free. And so accessing PrEP is something that is readily available to most patients at very little or no cost.

There are also patient assist programs from the state and from the different drug companies. And the providers at Summa are knowledgeable about all of those different programs and can link patients into those programs to access. And additionally, anyone who's interested in PrEP can also visit Summas website. And if you search for the Care Center under that website, not only can you learn more about the Care Center and the providers there, but there are links for additional informational websites, and some of those websites include PrEP.


Host: Yeah, that's awesome. Actually, and that website is summahealth.org/care-center. This has been great today. Nice to meet both of you. Great to talk through this. As I said, a lot of great information. We hope listeners agree. Thanks so much.


Amy Hite, M.D: Thank you for having us.


John Tomich, M.D.:
Thank you for having us.


Host: And if you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.

About the Authors

John W Tomich, MD

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Amy Hite, MD

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While most people with COVID-19 recover and return to normal health within a few weeks, others have symptoms that linger for months after recovery. Even people who have had mild versions of the virus can experience persistent or late symptoms. These people are often referred to as "long haulers" and the condition has been termed post-COVID syndrome or "long COVID-19."

Getting Help for Long-Term Post-COVID Symptoms [Podcast]

While most people with COVID-19 recover and return to normal health within a few weeks, others have symptoms that linger for months after recovery. Even people who have had mild versions of the virus can experience persistent or late symptoms. These people are often referred to as "long haulers" and the condition has been termed post-COVID syndrome or "long COVID-19."

Maternal Health in the Black Community [Podcast]

Dr. Cheryl Johnson leads a discussion focusing on empowerment in the African American community, especially maternal health.

Testicular Cancer: An Overview from Prevention to Treatment [Podcast]

Dr. Dankoff provides an overview of testicular cancer. Learn about symptoms, prevention, and treatment options.

What Makes a Great Doctor - Personal Insights, Advice, and Why they Chose Medicine [Podcast]

Dr. Shanu Agarwal and resident Kortnie Broschinsky discuss their journey into healthcare.

Occupational Therapy: What Is It, How Does It Help, Who Should See An OT [Podcast]

Craig Wood leads a discussion focusing on occupational therapy, its benefits, and why he got into the field.

Our Commitment to Creating a Healthier Community [Podcast]

Iriel Hopkins and Marlo Schmidt discuss ways in which Summa Health System contributes to a healthier community.

Sudden Infant Death Syndrome – What You Need to Know [Podcast]

Karen Frantz DeSeptis and Ericka Malone lead a discussion on SIDS, and important information you need to know.

An Overview of Osteoporosis: Prevention to Treatment [Podcast]

Natalie Hiltbrand, an Osteoporosis Specialist at Summa Health, leads a discussion on osteoporosis treatment, as well as prevention.

What You Know About Sepsis Could Save Your Life

Whether it is a urinary tract infection, sinus infection, or an infected wound, most people consider these things to be a part of life. While many infections clear up on their own or with antibiotic medications, some infections progress to a life-threatening condition called sepsis.

According to the Sepsis Alliance, 1.7 million Americans are diagnosed with sepsis every year. What’s more, sepsis is the leading cause of death in U.S. hospitals, accounting for 35% of all…

Addressing Common Pelvic Health Issues [Podcast]

Dr. Megan Cesta and senior physical therapist Amy Senn discuss common pelvic health issues women may experience.

Coming Out: How to Feel and Show Support During a Time of Vulnerability [Podcast]

Healthy VitalsWe talk about tips on how to go about telling friends and family. And for friends and family, ways to show support when loved ones share with you.

Why is it so important to get your flu shot this year?

Last winter, the community took several precautions to help stop the spread of COVID-19. From masks and social distancing to virtual work and school to cancelled events, an unforeseen positive side effect was a less intense flu season.  

Flu cases documented during last year’s flu season were historically low by a wide margin. Medical professionals haven’t seen anything like it.  

So with many precautions still in place amidst an ongoing pandemic, you may be…

How to tell the difference between COVID-19 and seasonal allergies

At the first sign of a scratchy throat or cough, people can’t help but wonder whether they’ve contracted COVID-19 — and rightfully so.

But just because you have a sore throat and cough, doesn’t necessarily mean that you’ve contracted COVID-19. Pollen counts are high, affecting you or someone you know with seasonal allergies.

COVID-19and seasonal allergies both affect the respiratory system and share similar symptoms, so it can be difficult to…

What does it mean to be an LGBTQ ally?

Anyone, regardless of their sexual orientation or gender identity, can support the LGBTQ (Lesbian, Gay, Bisexual, Transgender and Questioning) community. But being an ally of this population takes action. Allies work to stay informed on current LGBT issues and events. They speak up for what’s right and they support equality by fighting for policies that protect LGBTQ individuals from discrimination.

Allies are important and welcomed supporters of the LGBTQ movement, as…

Closing the gap on health disparities in the LGBTQ community

All of us rely on healthcare services at one time or another — and many of us take them for granted. But the sad truth is in today’s world, access to medical advice and treatment isn’t equal.

It is true LGBTQ (Lesbian, Gay, Bisexual, Transgender and Questioning) individuals face health disparities in a number of ways. As a result, this community is at a higher risk for certain medical conditions, has less access to healthcare and experiences worse health…

Coughing etiquette 101

When you are suffering from a respiratory infection, you risk spreading the infection through your cough. In fact, each cough expels thousands of tiny, infectious droplets that travel up to six feet away.

Those droplets can be inhaled by others or land on their face. Droplets also can fall on and contaminate nearby surfaces, where they can be easily transferred to another’s hands.

Coughing etiquette, combined with facial coverings and social distancing, is the best way to…

5 unusual COVID-19 symptoms you need to know about

Fever, dry cough and shortness of breath are the telltale signs of a COVID-19 infection. But, those aren’t the only symptoms that have been linked to the virus. Other symptoms include chills, muscle or body aches, sore throat, fatigue and congestion.

As we learn more about this dangerous virus and its full range of symptoms, doctors are uncovering yet another set that are unusual and uncommon. From lesions to vomiting to deadly blood clots, doctors are discovering COVID-19 is…

All About Sleep Apnea [Podcast]

Dr. James Bavis & Dr. Ketan Deoras explain sleep apnea as well as signs, symptoms, and what to expect.

Breast Cancer: The Importance of Knowing Your Risk [Podcast]

Dr. Keristen Brantley & Dr. Victoria Van Fossen discuss Breast Cancer Prevention and Treatment.

Alzheimer’s Awareness: Symptoms, Stages, and Support [Podcast]

Amanda Harvan sheds light on the symptoms, stages and support of Alzheimer's.

Importance of flu shots—even in a pandemic

With an ongoing COVID-19 pandemic and influenza (flu) season now upon us, getting the flu vaccine should be at the top of your family’s to-do list this fall.

The Centers for Disease Control and Prevention (CDC) believe both the flu virus and COVID-19 could be running rampant this season. That’s why many medical experts agree this year the flu shot is more important than ever before.

Influenza activity often begins to increase in October and peaks between December and…

Men’s Well-Being: All About Prostate Health [Podcast]

Dr. Kevin Spear discusses men's health and different risk factors and how to ensure optimal well-being.

Summa Health's infectious disease specialist Dr. Thomas File offers the latest updates on COVID-19

We’ve learned a lot about the novel coronavirus (COVID-19) in the past six to eight months since the virus infiltrated our lives and bodies. We now know much more about how it’s spread, symptoms to watch for and how to treat some of them, as well as successful ways to protect ourselves from transmission. 

But, there’s still a long road ahead. There are many unknowns about the virus, including immunity and long-term effects. Summa Health sits down with…

The Latest Updates on COVID-19 [Podcast]

Dr. Thomas File shares the latest updates on COVID-19.

The Latest Updates on COVID-19 [Podcast]

Dr. Thomas File shares the latest updates on COVID-19.

Can Obesity be Considered a Disease [Podcast]

Dr. Adrian Dan discusses obesity as a metabolic disease.

Breaking the Stigma of Mental Illness [Podcast]

Emily Hionides-Horner discusses 7 ways to overcome mental health stigma.

The Modern Guide to Heart Health [Podcast]

Dr. Peter Bittenbender shares his insight on the modern guide to heart health.

Tips on Maintaining Fitness and Physical Health During the Pandemic [Podcast]

Dr. Cipriani discusses tips on maintaining physician health during the pandemic.

Tips for Managing Anxiety [Podcast]

Dr. Leslie Zaynor discusses tips for managing anxiety.

Are outdoor activities safe amidst the COVID-19 pandemic?

As weeks pass by under Ohio’s stay-at-home order, cabin fever is starting to set in for many of us. With nowhere to go and calendars cleared, families are jumping at the chance to get outdoors. Taking your activity outside is a great way to boost your health and wellbeing however, we must take extra precautions to slow the spread of Covid-19.

With summer around the corner there are many things we all look forward to doing outdoors. From cleaning up and planting our…

Myth vs. Fact: What you need to know to protect yourself from COVID-19

New headlines and reports about the novel coronavirus (COVID-19) are infiltrating the Internet, TV, and social media channels daily, if not hourly. Much of this information is vital for our safety and protection against the virus. However, amidst this global pandemic, there are many myths being passed around that could potentially do more harm than good.

 

Summa Health is getting to the bottom of the most pertinent questions it is hearing to separate the myths from facts.…

Fighting Coronavirus: When and how to self-quarantine

Handwashing and social distancing help prevent the spread of COVID-19, but certain situations may require more. If you have been in an office or gathering with someone who developed a confirmed case of COVID-19, you may be concerned that you have become infected as well whether you are exhibiting symptoms or not.

Should you quarantine yourself? If so, how and for how long? The Centers for Disease Control and Prevention (CDC) recommend self-quarantine only if you have a medium…

How COVID-19 Affects People With Chronic Diseases

What is COVID-19? 

COVID-19 stands for “COronaVIrus Disease 2019.  COVID-19 is the disease caused by SARS-CoV2 which is a type of coronavirus.  It is characterized by fever, cough, and shortness of breath, but it is only one of many viruses that can cause similar symptoms. In the context of the current outbreak, COVID-19, SARS-CoV2, and coronavirus are often used interchangeably.

Novel Coronavirus: How Summa Health is preparing for any scenario to help keep their staff and patients safe

Everywhere you turn, there are new headlines reporting on the increasing number of cases and unfortunate deaths due to the novel coronavirus. It’s a respiratory infection that was first identified in Wuhan, China, late last year.

At the time of this post, the outbreak has been detected in more than 35 countries, including those in the United States. The virus has been named “SARS-CoV-2” and the disease it causes has been named “coronavirus disease 2019…

5 Things You Need to Know About HPV to Protect Yourself

Reviewed January 2025

By now, you’ve probably heard about human papillomavirus (HPV). Maybe you heard about it in a TV commercial, read about it in a magazine, or maybe you or your child’s doctor recommended the HPV vaccine. But, why is everyone talking about it? Should you be concerned?

According to the Centers for Disease Control and Prevention (CDC), HPV is the most common sexually transmitted disease in the United States and nearly 80 million people in this…

Novel Coronavirus: Here’s what you need to know

Everywhere you turn, there are new headlines reporting on the increasing number of cases and unfortunate deaths due to the novel coronavirus. It’s a respiratory infection that was first identified in Wuhan, China, late last year.

At the time of this post, there have been more than 9800 confirmed cases in China and a dozen other countries, including the United States, and 213 deaths due to the coronavirus.

The Centers for Disease Control and Prevention (CDC) considers the…

Hepatitis: What you need to know

Did you know the liver is the second largest organ of the entire body, after the skin? It’s also incredibly important: essential for food digestion, stores a large amount of your body’s energy and is a cleaning machine, eliminating toxins in the body. Hepatitis, usually caused by a type of virus, is an inflammation of the liver.

There are 5 types of Hepatitis, but Hepatitis A, B and C are the most common. Each type has different symptoms and treatment options.…

Should my teen get the HPV vaccination?

The human papillomavirus (HPV) is a group of more than 150 related viruses. Each HPV virus is identified by a number, known as its “type or strain.” Some of these viruses do nothing at all, some strains lead to genital warts while others can lead to serious types of cancer.

HPV is very common. In fact, at least 14 million people become infected each year. Some estimate at least 40 percent of Americans have at least one strain. The virus is transmitted through intimate skin-to-skin contact with someone who has the virus, during vaginal, anal or oral sex. HPV is so common that nearly all men and women come in contact with an HPV virus at some point in their lives.

Why Adult Immunizations Are Important Too

August is National Immunization Awareness Month. While we mostly think of trips to our child’s primary care physician for shots, it’s very important to maintain our immunization record as we age. Even if you received all of the recommended vaccines as a child, the protection on certain immunizations can decrease over time. You could also be at a higher risk for certain diseases due to travel, job, age, lifestyle or other health conditions.

Ticks and Lyme Disease: Why are rates so high?

Warmer weather is in full force now, and for many of us this season means outdoor activities including camping and exploring, plus the insects that call these spots home.

According to the Centers for Disease Control, there are more than 36,000 cases of Lyme disease reported each year and hundreds to thousands of cases go unreported. Since the CDC began tracking this disease, the number of annual cases has increased dramatically. Between 2004 and 2016, researchers found cases almost doubled from 19,804 to 36,429.

Before we get into possible causes of this increase, let’s explore what Lyme disease is and how to tell if you may have been infected.

PrEP An important tool in HIV prevention

In the United States, about one million people are living with HIV infection, but it’s estimated that 1 in 7 of those infected is not aware that that he or she is HIV positive. Pre-Exposure Prophylaxis, or PrEP, is where HIV-negative people take a medication to reduce their risk of getting HIV. Currently the only FDA-approved medication for PrEP is Truvada, which is taken once daily for prevention.


Mental Health in the LGBTQ Community

LGBTQ individuals are almost three times more likely than others to experience a mental health condition such as depression or anxiety and LGBTQ individuals have a higher rate of suicide as compared to those in the general population. Much of this is due to minority stress. Minority stress within the LGBTQ community stems from a variety of factors including social stigma, discrimination, prejudice, denial of civil and human rights, abuse, harassment, victimization, social…

National Lesbian Gay Bisexual and Transgender LGBT Health Awareness Week

The medical definition of sexual orientation is “an enduring, emotional, romantic or sexual attraction that one feels toward men or women, or both.” While this definition may suffice for the purposes of education, one truth I have learned is there is no single definition that can encompass all of human sexual orientation, identity or gender identity.

Summa Health is an inclusive healthcare provider whose mission is to provide the right access to the right care for…

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