Preparing for PrEP Side Effects

Black Americans make up 12 percent of the U.S. population, but roughly 54 percent of Black American women have been diagnosed with HIV. PrEP, or pre-exposure prophylaxis, does the work of trying to keep those percentages down by preventing HIV, and is typically prescribed for those who may be at higher risk for contracting the virus.

PrEP is covered by most health insurance, and the most common brands prescribed are Descovy, Truvada, and Apretude. Like most prescribed medications, all three brands feature side effects, but bone density loss and kidney damage are two of the more concerning effects to be aware of.

Descovy works by blocking the activity of the HIV enzyme, stopping the ability of HIV to replicate. The more common side effects from taking Descovy include nausea, diarrhea, depression, fatigue, and loss of appetite. Some patients develop a rash, feelings of dizziness, insomnia, or headache. Most of these can be mild and go away on their own after a few days or weeks. Although, Descovy is administered by prescription only and taken once daily, it is not habit-forming. It is also very important to be tested and confirmed as HIV negative before taking Descovy.

Truvada is comprised of two medications called tenofovir and emtricitabine, which work together to block pathways that HIV uses to establish infection. It must be taken every day for seven days for the patient to achieve full protection. Similar to Descovy, headaches, rash, and nausea count as common side effects. However, Truvada’s more serious side effects include liver problems, bone density loss, and the kidneys’ decreased ability to filter toxins. The milder side effects tend to go away within a week or two.

Black women who are longtime Truvada users should be especially aware of the potential side effect called lactic acidosis, identified as a buildup of lactic acid in the bloodstream. This condition presents symptoms including abdominal pain, fatigue or weakness, decreased appetite and difficulty breathing. Treatment for this particular side effect comes in the form of intravenously administered sodium bicarbonate.

First approved by the FDA in 2021, Apretude is an antiretroviral injection that blocks the HIV enzyme integrase from replicating itself. It’s recommended as an alternative to oral PrEP, which may be more likely to impact renal function. The injection is given every other month, as opposed to a daily pill. A medical trial conducted in 2023 concluded that, compared to Truvada’s 75 percent efficacy, Apretude displayed a 90 percent reduction in the risk of getting HIV. In addition to the common side effects of fever, chills, injection site reactions, fatigue and headache, there is a potential risk of developing liver problems or worsening existing liver problems in more severe cases.

In the off chance a patient becomes HIV positive while using PrEP medications, the treatment regimen must pivot to full HIV treatment because taking PrEP while having HIV actually makes it more difficult to treat the virus. The most commonly recommended course is antiretroviral therapy, which is two or more medicines from any of the five classes of anti-HIV medicines. These include Ziagen, Biktarvy, Selzentry, and Reyataz. They should all be taken strictly as prescribed to maintain the immune system’s strength and lower chances of HIV transmission.

Some of the side effects from PrEP medications may understandably be too much for some people to manage. There is always the option to stop taking PrEP, but it does come with the immediately increased risk of contracting HIV as soon as PrEP treatment stops. In this case, the extra precaution of condom use is strongly advised. Always remember that there are still people everywhere who still live full, happy lives while HIV positive.

By Michelle Felix | Published March 14, 2025