Once you and your healthcare provider decide PrEP is a good choice for you, they’re going to need to have you complete some really important tests. These tests are listed below, and you should make sure you know about them, just in case your doctor isn’t familiar with all the steps to prescribing PrEP. If your doctor doesn’t ask for one of these tests, it’s essential that you let them know, because not getting one of them could cause big complications later on. Here is the printable fact sheet that has some helpful hints on talking to your provider about PrEP, and a brief list of all the required tests you need before and after starting PrEP- just in case they aren't familiar with PrEP, and aren't sure what tests you need.
Before Starting PrEP: The Tests
- HIV: It’s essential you get an HIV test before you start PrEP. If you start PrEP and are positive but don’t know it, it can be a big issue. Even though Truvada is used as an HIV treatment drug, on its own it isn’t powerful enough to control the virus. This means if you’re taking PrEP but are HIV positive and don’t know it, the virus could mutate and become resistant to Truvada. Because Truvada is considered a ‘frontline’ medication for HIV treatment (because it’s so safe and well-tolerated), it’s important that it is only reserved for proper use in combination with other drugs for HIV treatment and prevention. After you take your HIV test, your provider will likely recommend that you avoid any sexual activity that can pass HIV for about seven days after you start Truvada for PrEP. This is just to make sure you have enough medication in your bloodstream to protect against HIV before you have sex.
- Hepatitis B: Truvada can also cause complications for guys who have Hepatitis B, even if they don’t know it. It can also cause complications for guys who contract Hep B after they start PrEP. So, another essential test is a Hep B test if you haven’t been vaccinated, or what’s called a ‘titer reading’ if you have been vaccinated. A titer reading tells your provider how active your vaccination is, and will help them determine if you should be re-vaccinated. If you haven’t been vaccinated against Hep B., you will need to be before you can start PrEP.
- Kidney function test: because a very small number of guys will have decreased kidney function as a side effect of PrEP, your provider should test your kidney function before you start PrEP, and also one month after. This will let you and your provider know if it’s safe to start, and will also let you both know very quickly if any kidney issues arise. The specific test your doctor should ask for will measure (or estimate) how efficiently your kidney’s clear a kind of protein called ‘creatinine.’
- STI tests: STI screening is also part of initiating PrEP, both when you start and for however long you take the medication. REMEMBER: PrEP DOES NOT PROTECT AGAINST ANY OTHER STIs! Vancouver is currently experiencing a significant syphilis outbreak, and rates of other STIs here remain high. For many reasons, you should get tested every three months. One great thing about PrEP is STI testing becomes a more regular part of your overall healthcare regimen!
While You’re on PrEP: The Tests
- HIV: even though you’re taking PrEP to prevent HIV transmission, you’ll still need to get tested for HIV every three months. Because PrEP is still pretty new, researchers are following users closely to make sure it’s as effective as the studies indicate. We also know that all HIV prevention methods, including condoms and PrEP, will not work 100% of the time. Getting tested for HIV every three months ensures that in cases where PrEP didn’t work to prevent HIV transmission, guys can get the treatment they need immediately.
- STI tests: Because researchers have established that some (though not most) guys might change how they use condoms after they start PrEP, you’ll need to get tested for all STIs every three months, even if you’re still using condoms. These are part of the guidelines established by Health Canada, so remember that if your doctor or nurse practitioner isn’t asking for these tests, they’re not following the guidelines, and you might want to find a provider who knows more about PrEP. As we have noted before, STI rates in Vancouver are high, and some, like syphilis, are now considered outbreaks. It’s important to get your STI tests for your PrEP regimen, but all guys should be getting tested a lot more frequently, and taking more steps to protect themselves and others from STI transmission through safer sex methods.
- Kidney function test: just like we talked about above, PrEP can impact kidney function for a small number of guys. Usually this happens pretty soon after you start the medication, but it can also develop later on, so your provider should be making sure you have your kidney function / creatinine clearance tested every three months as well.