PrEP stands for Pre-Exposure Prophylaxis.
PrEP is a way for people who don’t have HIV, but who are at high risk of getting it, to prevent HIV infection. This is by taking a pill containing two medicines that are also used to treat HIV at periods of high risk. If you take PrEP and are exposed to HIV through sex, these medicines can work to keep the virus from taking hold in your body.
PrEP can be combined with condoms and other prevention methods to provide even greater protection than when used alone.
There are two proven ways of using PrEP when the risk is from anal sex. One is to take it all the time during periods of risk (the PROUD study) and the other (the IPERGAY study) is to take a double dose 2-24 hours before you know you are going to have risky sex and then daily until 48 hours after you stop having risky sex. Both methods have been proven to work, but there is more research to support the PROUD method of daily use. For vaginal sex only, this daily method has been proven to work. People who use PrEP must be HIV-negative and must commit to taking the drugs properly. They need regular HIV and STI testing, regular checks that the drugs have no serious side effects and regular blood and urine tests to make sure that the drugs are not affecting your kidneys. This is because if PrEP is used after HIV infection, it can make treatment more complicated.
PrEP is not suitable for everyone. The aim of PrEP is for it to be used for people who are HIV-negative and at high risk of HIV infection. This may include anyone who is in an ongoing relationship with an untreated HIV+ partner, as well as for people who are having risky unprotected sex who find it difficult to consistently use condoms as a prevention method.
People who inject drugs or have shared needles might also consider using PrEP. For example, if you engage in chemsex, PrEP will not protect you against hepatitis C and it is unclear how effective it is for preventing HIV infection from injecting.
If you have a partner who is HIV+ and you are considering getting pregnant, talk to your GP about PrEP. It may be an option to protect you and your baby.
PrEP involves taking medication regularly during periods of high risk and regular visits to a GP or other clinic for urine and electrolyte tests to monitor your kidney health, plus regular HIV screening tests.
PrEP should only be used for people who are at ongoing substantial risk of HIV infection. For people who need to prevent HIV after a single high-risk event of potential HIV exposure—such as sex without a condom, needle-sharing injecting drug use, or sexual assault—there is another option called Post-Exposure Prophylaxis after Sexual Exposure, or PEPSE, where treatment must begin within 72 hours of exposure. You can read more about PEPSE here.
It’s also important to remember that taking PrEP will not prevent you from getting other STIs, such as syphilis, gonorrhoea, hepatitis C and chlamydia, nor from becoming pregnant.
In the recent PROUD and IPERGAY studies, PrEP has been shown to significantly reduce the risk of HIV infection in people who are at high risk from anal sex by as much as 86%, overall. It is thought that the infections that did occur were in people who did not take their medication properly. There has been a report of someone on PrEP who became infected by someone with an antiviral-resistant virus.
PrEP is much less effective if it is not taken properly PrEP can be even more effective if it is combined with other ways to prevent HIV infection, such as condoms, drug treatment, and adherence to treatment for people living with HIV to further reduce the chance of HIV being passed on.
Read more about PrEP and the PROUD and IPERGAY studies here:
http://www.aidsmap.com/PrEP/cat/1623/
http://i-base.info/qa-on-prep-in-the-uk-and-changes-to-the-hiv-proud-study/
Some people in clinical studies of PrEP had early side effects such as an upset stomach or loss of appetite and headache, but these are usually mild and go away within the first month. Some people had some kidney disturbance, but this did not lead to serious long-term kidney problems.
The medication used in PrEP has been used to treat people living with HIV for many years and has been shown to be at low risk of serious side effects. However, if you experience side effects of using PrEP, you should discuss this with the GP or clinic where you have your regular checkups. Ideally, you have a kidney function blood test and a urine test before you start and may need to repeat them if you remain on PrEP.
From 5 October 2020, PrEP is available on the NHS in Birmingham and Solihull via Umbrella Health. Please note that this is with tenofovir disoproxil fumarate, and not the newer tenofovir alfenamide.
If you would like access PrEP on the NHS, please call Umbrella Health on 0121 237 5700. You may then be booked into a telephone clinic initially. You will need sexual health tests, and in particular a negative HIV test before you start PrEP.
If you have any other queries, please call Birmingham LGBT on 0121 643 0821 and ask to speak to a member of the sexual health team.
PrEP is now available on the NHS in the UK. Some people still choose, for various reasons, to purchase PrEP online.
NB: The NHS will only supply tenofovir disoproxil fumarate and not tenofovir alfenamide.
There are always risks in buying anything online, but we have included the following links for you to obtain more information if you are considering buying or acquiring PrEP:
Can I get PrEP privately in the UK?:
Where can I buy PrEP online and is it legal in the UK?:
https://www.iwantprepnow.co.uk/
How can I check that PrEP I buy from the internet is genuine?: http://i-base.info/qa/10695
How do I safely use PrEP if I buy it online?:
Recommended reading if considering buying PrEP online: www.iwantprepnow.co.uk and http://prepster.info/
The pill used by people using PrEP for daily use who are at high risk of getting HIV infection is called Truvada®.
Truvada® is a combination of two HIV medications (tenofovir and emtricitabine). In other parts of the world it is available as a cheaper generic (non patented) product. Most commonly this is from an Indian company called Cipla. These medicines work by blocking important pathways that HIV uses to set up an infection. If you take PrEP daily, the presence of the medicine in your bloodstream can stop HIV from taking hold and infecting you with the virus.
Dosage is very important: If you do not take PrEP properly there may not be enough medicine in your bloodstream to block the HIV virus. If you become infected with HIV, the virus may then have some resistance to Truvada and may affect your later treatment.
Read more about PrEP and the PROUD and IPERGAY studies here:
http://www.aidsmap.com/PrEP/cat/1623/
http://i-base.info/qa-on-prep-in-the-uk-and-changes-to-the-hiv-proud-study/
http://www.ipergaymtl.com/en/about-us.html
http://www.aidsmap.com/Pre-exposure-prophylaxis-also-stops-86-of-HIV-infections-in-Ipergay-study/page/2947854/
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