HIV AND PREVENTION PRE-EXPOSURE PROPHYLAXIS (PrEP)

Dr Tariq Jagnarine
Fam Medicine, Endocrinology/Diabetes

Pre-exposure prophylaxis (PrEP) is a course of HIV drugs taken by HIV-negative people to protect themselves against HIV infection. Truvada, an antiretroviral drug, has been approved for use as PrEP in many countries. Truvada is a single pill that is a combination of two anti-HIV drugs, tenofovir and emtricitabine. PrEP is different from PEP (Post-exposure prophylaxis), which is an emergency treatment for HIV, taken after possible exposure to the virus.

FAST FACTS
* Pre-exposure prophylaxis (PrEP) is a course of HIV drugs taken by HIV-negative people to prevent infection.
* Taking PrEP correctly would virtually eliminate a person’s risk of getting HIV, with efficacy from 70% to 90%.
* PrEP does not protect against other sexually transmitted infections (STIs) such as syphilis, gonorrhoea, or hepatitis C. Condoms are still the best protection from these STIs.
* PrEP is not taken for life; it is taken only for short periods, when a person may be at risk of HIV infection.

ACTION
The anti-HIV drugs in PrEP stop the virus from replicating in a person’s body. If someone is exposed to HIV, for example during sex without a condom, but has been taking PrEP correctly, there will be high enough levels of the drugs to prevent that person from getting HIV.

EFFECTIVENESS
If used consistently and correctly, PrEP would virtually eliminate the risk of becoming infected with HIV. A number of large, high profile trials undertaken across the world have continued to prove PrEP’s effectiveness as much as 70% to 90%.

PrEP AND CONDOMS
PrEP would protect persons from HIV, but it doesn’t give any protection against sexually transmitted infections (STIs). Using a condom is the best way to prevent other STIs, such as gonorrhoea, Chlamydia and hepatitis C. Also, PrEP doesn’t prevent pregnancy.

WHO CAN TAKE PrEP?
PrEP is for people who are HIV-negative and more at risk of HIV infection. PrEP can be used by men and women, both Trans and cisgender.
PrEP may be a good option for:
* Persons in an ongoing sexual relationship with a partner living with HIV, who does not have an undetectable viral load. (serodiscordant couples)
* Gay or bisexual men who have multiple sexual partners and don’t always use condoms.
* Gay or bisexual man in a new sexual relationship but not yet aware of their partner’s HIV status, and don’t always use condoms.
* Persons who do not use condoms with partners of the opposite sex, whose HIV status is unknown and who are at high risk of HIV infection (for example, they inject drugs, have multiple partners, or have bisexual male partners)
* Having sex for money, or receive gifts for sex. For example, female sex workers
* Sharing injecting equipment, or have been in a treatment programme for injecting drug use.

CAN PrEP WORK FOR ALL TYPES OF SEX?
Yes. PrEP can prevent HIV infection during both vaginal and anal sex, but there are different recommendations for how to take it, depending on a person’s gender and the type of sexual interaction.

TREATMENT OPTIONS
There are two ways to take PrEP:
* One tablet per day
Recommended for:
* Women (both trans and cisgender)
* Transgender men having vaginal/frontal sex
* Men having vaginal or anal sex with women
* Gay and bisexual men

Caution
PrEP needs to be taken for 7 days before protection is achieved, and then every day for as long as protection from HIV is needed.
* Event-based (on-demand), where you take PrEP before and after planned sex
Recommended for:
* Gay and bisexual men

Caution
This option would work only if persons had planned for sex at least two hours in advance, or can delay having sex for at least two hours.
There are different types of event-based PrEP, depending on one’s pattern of sexual activity. Talk this option through with a health professional.

HOW CAN I START PrEP, AND FOR HOW LONG DO I TAKE IT?
An HIV test must be taken before starting PrEP, to be sure that persons do not have HIV. Once positive for HIV, taking PrEP may increase the likelihood of developing drug resistance, which makes HIV treatment less effective. The positive HIV cases need to be on regular ARV treatment for HIV instead.
While taking PrEP, a visit to the healthcare professionals for regular check-ups (at least every three months) is important.
Unlike HIV treatment, people do not stay on PrEP for life. PrEP is normally taken for periods of weeks, months, or a few years when a person feels most at risk of HIV. This might be during specific relationships; after the break-up of a relationship; and when dating new people, planning a holiday, knowing of desire to be sexually active with new people whose status may be unknown; while dealing with drug use problems, or when trying to conceive by HIV-positive stable HIV partner.

SIDE EFFECTS
Around one in ten people taking Truvada as PrEP experience short-term side effects in the first few weeks of taking it. These problems, such as stomach problems, headaches and tiredness, are usually minor, and go away after a week or two.
Long-term side effects are rare. Up to 2% of people taking PrEP have small decreases in kidney function while taking it. This usually returns to normal after taking PrEP has ceased.
Healthcare providers monitor the kidney function of people taking PrEP frequently.
While some people have expressed concern about the use of PrEP leading to the development of drug-resistant HIV, this has rarely happened in practice.

ACCESS TO PrEP
PrEP is currently available at ALL care and treatment sites (HIV treatment sites) throughout Guyana. It is free of charge, and is an option available to all high-risk HIV-negative persons.
Persons who are interested in getting PrEP can contact a healthcare professional, who should be able to provide advice on how and where to access the service. The healthcare professional would also be able to offer any advice, monitoring, and support to help take PrEP correctly, and ensure the best protection possible.