A Patient’s Perspective: Factors Influencing My PrEP Persistence

Key Takeaways

• I take PrEP to protect myself both during and between relationships, regardless of my partner’s sexual activity.
• I gained a little weight with PrEP, but the benefits of HIV prevention outweighed that.
• I focused on diet, exercise, and working with my doctor on modifying my other medications to mitigate weight gain.

My Use of PrEP During and Between Relationships
I have been taking preexposure prophylaxis (PrEP) since 2016, when I was with a partner living with HIV. I knew some things about PrEP, but we had a conversation where my partner shared his experience taking antiretroviral therapy. Even though his viral load was undetectable, I decided to take PrEP for extra protection. We wanted to be cautious when we began having condomless sex. 

After that relationship ended and there were fluctuations in my sexual activities, I decided to stay on PrEP for my self-empowerment and protection. I tell people that even if they have sex only once a year, that one time could be the time they needed PrEP. So, I choose to be prepared for anything that could happen.

I’m now in a long-term relationship that is long distance, and although that doesn’t necessarily mean there will be cheating, I’m taking PrEP to ensure that I stay protected. I’ve known a lot of people who contracted HIV because they trusted someone. I understand that part of being in a relationship is a level of vulnerability, but I’d rather not be physically vulnerable. I will let my emotional guards down, but my physical guards stay up. It’s not that I don’t trust the other person—but the PrEP is something I do just for me.

I’m blessed to have a partner who is okay with me staying on PrEP. He thinks that if PrEP isn’t hurting me and is supposed to help, I should stay on it. I might decide to stop PrEP if we were spending a lot more time together or moved in together—when I could be absolutely sure we were monogamous.

My Experience With Weight Gain From PrEP
I was first started on emtricitabine (FTC)/tenofovir disoproxil fumarate. But I talked to folks living with HIV for 10 years or so who described issues with bone density, creatinine, and kidney issues while taking this drug. These potential side effects made me wonder what other options were out there.

In late 2020 or early 2021, I switched to FTC/tenofovir alafenamide (TAF). It was new, and I read about its effectiveness in papers and presentations. Although it didn’t seem perfect, to me it seemed to have a better side effect profile in the long run. However, I only recently learned that weight gain is possible. 

I have gained approximately 10-15 pounds, and at first, I thought it was from something related to diet or exercise during the pandemic. I also take psychiatric medication, and some of those can affect weight, so I worked with my psychiatrist to try a lower dose. It didn’t seem to help, and neither did physical exercise or dieting. I then thought maybe it was from FTC/TAF, and that’s how I found out it can cause weight gain. 

To me, the 10 pounds is negligible compared with the protective effects of FTC/TAF. I didn’t feel like stopping it would be better because I would then run the risk of contracting HIV. So, I still take FTC/TAF, and I do the best I can with diet and exercise to maintain my current weight.

Your Thoughts?
Have any of your patients experienced weight gain from PrEP? If so, how has that affected their persistence on PrEP?