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PrEP

 

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[HIV] Pre-exposure Prophylaxis – PrEP

What is PrEP?
Pre-exposure prophylaxis involves taking medications that can protect against HIV infection. These drugs are used before exposure to infection (before sex) and for some time after exposure. PrEP consists in taking one tablet containing two anti-HIV medicines once a day.

Why is it worth to use PrEP?
The HIV epidemic in Poland and around the world is increasing and concerns mainly men having sexual contact with men (MSM). Every year, almost 1000 new infections are reported in Poland among MSM and about 300 in other groups.

Is PrEP a vaccine?
No. PrEP works differently than the vaccine. The vaccine is designed to "teach" the immune system to recognize and fight infection for many years. However, PrEP only works when tablets are taken before and after sex. When tablets are not used, there is no protection against infection.

What is used during PrEP?
Numerous clinical trials have demonstrated the efficacy of tenofovir and emtricitabine combined in one tablet. These drugs block important steps in the virus copying cycle and hinder infection. Taken as recommended, through their presence in the blood and in other tissues, they quite effectively prevent the virus from entering the body and developing a chronic infection. Their irregular use leads to too low a concentration (amount) of the drug in the body, which may not prevent HIV infection. That is why it is so important to take your tablets regularly once a day at regular intervals. There is also the possibility of taking these drugs temporarily (4 tablets in total: 2 tablets 2-12h before intercourse, 1 table after the intercourse and 1 table 48h after intercourse), which gives a similar degree of protection against HIV infection during anal intercourses as daily admission . These "ad hoc" dosages were only tested in MSM.

Is PrEP something for me?
PrEP is not a method for everyone. PrEP is recommended for people who have a very high risk of HIV infection, eg due to the non-use of a condom when dealing with a person infected with HIV. In addition, PrEP should be considered even if you do not know whether your partner is HIV positive, but you know that you are using or interacting with other people, and also if you have recently been diagnosed with a sexually transmitted infection (incl. syphilis, gonorrhea, chlamydia).

PrEP may also provide additional protection during the attempts to become pregnant with an HIV-infected partner.

How effective is PrEP?
Efficacy and safety of PrEP has been evaluated in several large clinical studies among men who have sex with men, men who have sexual contact with women and women who have sexual contact with men. All subjects in this study were first tested for HIV infection to ensure that they were no longer infected, and then were advised to take one tenofovir tablet with emtricitabine once a day. In addition, study participants received extensive counseling on the principles of safer sex, regular tests for other sexually transmitted infections, and regular condom storing. There were also two studies among MSM, during which medication was taken not on a daily basis, but before planned sexual contact. As part of these tests, the patient took 2 tablets 2 to 12 hours before the relationship. drug, then 1 tablet after 24 hours and 48 hours after intercourse. The other elements of the study were the same.

Several studies have shown that PrEP reduces the risk of HIV infection.

In the case of MSM, the risk decreased by 44% compared to the placebo group (i.e. without the drug). The value of 44% is the average for all participants of the study, both those who took the medicine regularly as well as those who received it very irregularly or did not take it at all. In the group of people declaring taking the majority of doses of PrEP, the risk decreased by 72%, and sometimes even by 96%.

For hetero pairs in which one person was infected with HIV, PrEP reduced the risk of infection by 75% compared to the placebo group. In the case of people declaring taking the majority of doses of the drug, the risk decreased by 90%.

In another study for men and women taking PrEP (not in relationships) the risk of HIV infection was reduced by 62% and by 85% when most doses were taken. In one study, the protective blood concentration of the drug was found only in less than 26% of women, which was explained by the fact that tablets were not accepted by the majority of women participating in this study. These women were therefore not protected against HIV infection in any way.

Is PrEP safe?
The safety of PrEP was also evaluated during clinical trials. Some of the patients reported early side effects in the form of nausea and loss of appetite, which subsided after a month. Some people also complained of low intensity headaches. There were no serious side effects.

If you have problems with regular medication or some doses, please report it to your doctor.

Can I stop using sex condoms while using PrEP?
You should not give up using condoms even when using PrEP. Daily and ad hoc (according to the recommended scheme), the use of PrEP significantly reduces the risk of HIV infection, but not 100%. Condoms, on the other hand, protect against HIV infection if used correctly and during any type of sex. They do not give a 100% guarantee of avoiding HIV infection when they burst, slip during sex or are not used correctly. In addition, the drugs used in PrEP do not protect against other sexually transmitted infections. However, the condom protects. The greatest benefits and the greatest protection against HIV infection and other sexually transmitted infections (including gonorrhea, chlamydia) can be achieved regularly by taking PrEP and using condoms.

How long should I use PrEP?
You should discuss this issue with your doctor. There are several reasons why patients are interrupting PrEP. One of them is the decrease in the risk of HIV infection due to changes in lifestyle. If you do not want to take pills or you forget about them too often, there is a possibility to develop other methods of protection against HIV infection with your doctor. Another reason for the termination of PrEP may be side effects that hinder the daily functioning or deterioration of blood tests. In these cases, the doctor will have to stop PrEP.

Who pays for PrEP?
Currently in Poland there is no reimbursement act or preventive program guaranteeing free access to PrEP. The costs of the drug, the costs of examinations, the costs of visits must be paid by the patient.

[developed on the basis of: Rules of care for people infected with HIV - recommendations of PTN AIDS 2017; CDC PrEP Resources: https://www.cdc.gov/hiv/risk/prep/index.html; WHO implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection - WHO 2017; EACS Guidelines version 8.2 - 2017]