It is unfortunate that we have not managed to produce medications capable of curing people suffering of AIDS yet. However, scientists have managed to produce some medications that prevent HIV infection with very high degree of success. Today we are fortunate to have PrEP (Pre-Exposure Prophylaxis) and PEP (Post Exposure Prophylaxis). What are they and what do we need to know about them?
PrEP Pre-Exposure Prophylaxis
What is PrEP?
PrEP is “Pre-Exposure Prophylaxis” for HIV. The goal of PrEP is to prevent HIV infection if you are exposed to HIV. This is done by taking a fixed-dose combination pill of Tenofovir+ Emtricitabine (e.g.Truvada®). Taking daily PrEP has been approved by the Food and Drug Administration in the United States since July 2012 for HIV prevention and has recently been approved by the Therapeutic Drugs Administration (TGA) in Australia.
Is PrEP for me?
PrEP is suitable for you, if you are at high risk of HIV infection. For example:
- If you are a man who has sex with men without using a condom. This is especially important if you have a sexual partner who has HIV infection and is not on treatment, or is at high risk of getting HIV.
Is PrEP covered under Medicare?
Yes. A fixed dose combination of Tenofovir + Emtricitabine (e.g.Truvada®) is currently listed on the Medicare Pharmaceutical Benefits Scheme (PBS) for use as PrEP for people with a valid Medicare card in Australia. If you have a Medicare card and a valid prescription, this means that PrEP medication can be purchased for a discounted rate at retail pharmacies in Australia.
If you do not have a Medicare card please check www.PAN.org.au for useful information about access to PrEP, including buying PrEP medication online.
Is PrEP effective?
Several studies have shown that PrEP reduced the risk of getting HIV infection. Men who have sex with men (MSM) who were given PrEP medication were 44 % overall less likely to get HIV infection compared to those who took no PrEP medication. Those who took the pill more regularly had a reduced risk of HIV infection by 73% or more, and up to 92% for others. More information on the details of the studies can be found at www.cdc.gov/hiv/prep
Is PrEP safe? What are the side effects?
The clinical trials also provided safety information on PrEP. Some people in the trials had early side-effects such as nausea, loss of appetite and headaches, but these were mild and usually disappeared within the first month. No serious side-effects were observed. A small proportion of people taking PrEP may develop kidney damage so it is very important you have kidney tests every three months when you are taking PrEP.
What do I have to do to get PrEP?
If you are interested in PrEP, speak to your doctor to see if you are suitable. If you are likely to benefit from taking PrEP, blood tests to assess your kidney and liver function, in addition to an HIV test, will be done. Once you have met the eligibility criteria and want to start PrEP, you will be given a prescription.
To find a doctor and for other important information about PrEP see the www.PAN.org.au website.
Taking PrEP will require you to have regular appointments with your doctor. You will have blood tests for HIV and other tests to see if your body is reacting well to the medication. You will also receive information about how to reduce the risk of acquiring HIV. You should take your medicine every day as prescribed, and your doctor will advise you about ways to help you remember to take it regularly. Tell your doctor if you are having trouble remembering to take your medicine or if you want to stop PrEP.
How do I get the PrEP medication?
If you have a Medicare card, PrEP medication can be purchased for a discounted rate at retail pharmacies in Australia. However, some pharmacies may need to order the medication, which may take a few days.
If you do not have a Medicare card, information is available at www.PAN.org.au about where to get PrEP.
Does PrEP protect me against other Sexually Transmitted Infections (STIs)?
No, PrEP does not protect you against other STIs like syphilis or gonorrhoea. If you have started taking PrEP, it is important for you to have regular STI screening as advised by your doctor.
I have heard about taking PrEP “as needed” instead of daily – will that be as effective?
Daily doses of PrEP medication are the best way to protect yourself. Results from the IPERGAY study, where PrEP was only taken for short periods just before and after having sex, do not conclusively recommend taking PrEP on an “as needed” basis. You can discuss this further with your prescribing doctor.
How long do I need to be on PrEP?
You should discuss this with your doctor. There are several reasons that people stop taking PrEP. If your risk of getting HIV infections becomes low because of changes that occur in your life, you may want to stop taking PrEP. If you find that you don’t want to take a pill every day or often forget to take your pills, other ways of protecting yourself from HIV infection may work better for you. If you have side effects from the medication that are interfering with your life, or if blood tests show that your body is reacting to PrEP in unsafe ways, your doctor may have to stop prescribing PrEP for you.
Are there any alternatives to PrEP?
Depending on your risk factors, you may be more suitable for other HIV prevention methods like PEP (Post Exposure Prophylaxis) or other safe sex strategies.
HIV Post Exposure Prophylaxis (PEP)
WHAT IS IT?
Post Exposure Prophylaxis (PEP) is the administration of antiretroviral HIV medications for 28 days, commenced within 72 hours of possible exposure to HIV infection.
Does it work?
PEP has been shown to reduce the risk of HIV infection following needle stick injuries to healthcare workers by 81%. However, it is unknown whether it is effective following sexual exposure, though animal and laboratory studies suggest that it is likely to be.
WHO SHOULD CONSIDER PEP?
Individuals who believe they may have been at risk of acquiring HIV infection following recent sexual exposure should discuss PEP with a doctor or nurse who can assess the risk and arrange PEP if it is considered advisable. An example of a risky sexual exposure could include condomless sexual intercourse with a person known to have HIV and who is not taking HIV medication.
If your risk is considered to be high PEP will generally be recommended. In other situations (e.g. a broken condom during heterosexual intercourse), the very low risk of HIV infection has to be balanced against the significant risk of side effects of medications, and PEP may not be recommended.
WHAT IS THE PROCESS IF I DECIDE TO TAKE PEP?
Initially, you will have baseline blood tests and swabs for HIV and other infections. You will then be given a four weeks supply of PEP medication. If your partner is HIV positive, it is useful to know what medication they are taking to help determine the best PEP medications for you.
You will receive a text within one week for a negative HIV test and a call if any of your swabs are positive. You will then be asked to attend the centre again in 6 weeks, for repeat blood tests.
HIV testing will be then be repeated 3 months after exposure.
It is important to take all tablets you are given as directed. If you miss doses, PEP is less effective.
NOTES ON PEP
- PEP should be commenced as soon as possible after potential exposure, within 72 hours.
- PEP is not a ‘morning after pill’ and does not replace the need for safe sex practices. We do not know how effective it is!
- PEP is not easy to take. Nausea, headache and diarrhoea are common side effects of HIV medications and may be severe.
- Safe sexual practices are essential until final testing at 3 months after exposure.
- Medications and testing are provided free of charge at MSHC.
This fact sheet is designed to provide you with information on Post Exposure Prophylaxis (PEP). It is not intended to replace the need for a consultation with your doctor. All clients are strongly advised to check with their doctor about any specific questions or concerns they may have. Every effort has been taken to ensure that the information in this pamphlet is correct at the time of printing.
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Or by Appointment Only Thur Evening Clinic: 5.00 -7.00pm
Contact Us: Ph: 03 9341 6200 Location:
Melbourne Sexual Health Centre
580 Swanston Street, Carlton, 3053 Vic
This fact sheet is designed to provide you with information on PrEP. It is not intended to replace the need for a consultation with your doctor. All clients are strongly advised to check with their doctor about any specific questions or concerns they may have. Every effort has been taken to ensure that the information in this pamphlet is correct at the time of printing.
Originally published by MSHC – Melbourne Sexual Health Centre