The Art of Prevention - An Introduction to PrEP

Over the past decade, there has been huge advancement in the field of virology, and one of the greatest medical breakthroughs has been the advancement in our knowledge and understanding of HIV/AIDS.

The great news is that today, there is an anti-viral treatment available that is hugely effective in lowering the risks of contracting HIV/AIDS, when taken consistently and in accordance with medical advice.

Below, we provide an introduction to that treatment; PrEP.

What is PrEP?

PrEP or pre-exposure prophylaxis refers to the proactive use of drugs to prevent disease in people who are deemed at particular risk of being exposed.

Nowadays, use of the word PrEP is colloquially used to describe specific antiviral drugs that are taken to prevent contracting HIV/AIDS.

PrEP is one of several HIV prevention strategies for people who are HIV negative, but whose lifestyle means that they have a heightened risk of acquiring HIV e.g. through sex or injection drug use.

The WHO recommends two anti-viral combinations for the use as PrEP for HIV/AIDS which are both taken as a single tablet. The best-known brand of PrEP medication worldwide is called Truvada which is a combination of tenofovir disoproxil (TD) and emtricitabine (FTC).

PrEP is only suitable for those who are HIV-negative. If you aren’t sure of your HIV status, it’s important to get testing before buying PrEP. It’s also important to know that PrEP doesn't protect against other STIs such as gonorrhoea or chlamydia.

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How does PrEP work?

PrEP contains a combination of two antiretroviral drugs (e.g. emtricitabine and tenofovir) which are also used to treat those that already have HIV. However, in PrEP, the dosages are different.

The two medicines work together in the body to fight off HIV before it has chance to establish in the body's cells and multiply. This essentially kills the virus so that the body remains HIV-negative.

In what circumstances should PrEP be taken?

PrEP is of benefit to people who are at a higher risk of HIV infection. This is generally thought to include;

  • People who do not always use condoms when having sex
  • Men who have sex with men
  • Trans men and women
  • Those with partners from parts of the world where HIV infection rates are high
  • Those with an HIV partner who does not have an undetectable viral load i.e. cannot pass HIV on through sex

Note that it is recommended that people who are already HIV-positive should not take PrEP.

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How well does PrEP work?

When taken consistently and as medically directed, studies have shown that PrEP substantially reduces the risk of HIV infection from both unprotected sex and drug use.

The studies show that PrEP is effective in reducing the risk of getting HIV from sex by about 99%.

Among people who inject drugs, studies show that PrEP is effective in reducing the risk of getting HIV by about 75%.

Does PrEP protect against STIs?

PrEP only protects you against HIV.

You need to take other precautions to reduce your risk of contracting other sexually transmitted infections (STIs) such as gonorrhoea, chlamydia, syphilis and hepatitis C.

Where appropriate, you should continue to use condoms as well as undertake regular STI testing. Health care providers may also advise to take HIV tests every three months.

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Is PrEP safe to take?

Research has shown that PrEP is generally safe and well tolerated for most patients, although as with all medication, side effects have been noted to occur for some.

Some patients experience a "start-up syndrome" with symptoms including nausea, headache, and stomach issues. These generally resolve themselves within a few weeks of starting the PrEP medication.

If you are taking PrEP, you should tell your health care provider about any side effects that are severe or do not go away.

How is PrEP taken?

PrEP can be taken as a daily tablet or on-demand.

Taking a daily tablet means that there is always some medicine in the body, providing continual protection whilst it is taken. A daily dose is suitable for people who have regular sex, say four or more times a week.

On-demand refers to taking a PrEP pill before and after the 'risk' event (referred to as EBD or Events-Based Dosing). Many people choose this method if they don’t have sex regularly.

If you’re expecting to have sex on a certain day, it’s recommended for you to take 2 tablets 2-24 hours before intercourse, another tablet 24 hours after the first dose, and one more tablet 24 hours after that.

Note that PrEP pills can only be used before having sex. If you only start the PrEP pills after sex, this is referred to post exposure prophylaxis (PEP) and alternative medical guidance is given.

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Written by Mike Firth, GP and Medical Director

This article is for informational purposes only and is not a substitute for professional medical advice or diagnosis. Always talk to your doctor about the risks and benefits of any treatment.

If you have any follow-up questions don't hesitate to contact us at help@manbehindthemirror.co.uk