A Guide To Pre-Exposure Prophylaxis For HIV

Scott McDougall
Scott McDougallMPharmDirector & Registered Manager

Despite tremendous progress in HIV treatment and prevention, an estimated 107,000 people in the United Kingdom are living with HIV today. Of those, about 5,000 people are unaware they are infected. This underscores the urgent need for accessible and effective prevention techniques to stop the spread of HIV.

Pre-exposure prophylaxis (PrEP) has emerged as one of the most promising new tools for HIV prevention. When taken as prescribed, PrEP medication can reduce the risk of contracting HIV through sex by about 99%. It provides an additional prevention choice for those at substantial risk of infection. However, knowledge gaps and misconceptions still surround PrEP.

In this guide, we'll empower you to make informed decisions about PrEP. Equipped with this knowledge, you can take proactive steps to safeguard your sexual health and potentially that of your partner.

What Is Pre-Exposure Prophylaxis?

Pre-exposure prophylaxis, or PrEP, is an HIV prevention method where people at high risk of HIV take anti-HIV medication to reduce their chances of contracting the virus. The key to PrEP is taking the prescribed daily medication consistently and as directed. When taken properly, PrEP has been shown to greatly minimise the risk of getting HIV from sex or injection drug use.

The concept behind PrEP is similar to preventive drugs for other conditions. For instance, if you take aspirin daily, you reduce your risk of heart disease and stroke. PrEP uses antiretroviral drugs for the same preventive principle - if HIV is in your system, the medication can stop the virus from taking hold and spreading infection.

PrEP is especially designed for people who, while being HIV-negative, find themselves at substantial risk due to various life circumstances. This includes certain demographics such as men who have sex with men, transgender people, heterosexual couples where one partner is HIV-positive, and people who engage in high-risk behaviours like sharing needles. PrEP offers hope and an additional protective layer for these individuals, allowing them to reclaim control over their health.

When used consistently and in combination with other prevention methods like condoms, PrEP can provide even stronger protection from HIV. It enables individuals at risk to take greater control over their sexual health.

How Does PrEP Work?

PrEP is made up of two main drugs, tenofovir and emtricitabine, which are also used to treat people who already have HIV. When taken consistently, these drugs work together to stop HIV from taking hold and spreading infection.

The medications act by building up protective levels inside the body. Higher concentrations accumulate in the tissues where HIV enters, like the rectum, vagina and blood. If exposure to the virus occurs, the drugs stand ready to attack HIV before permanent infection can happen.

Tenofovir and emtricitabine work as a team to block HIV in two main ways:

  1. Tenofovir stops the virus from making copies of itself inside our cells. Without this replication, the virus cannot duplicate and spread.
  2. Emtricitabine interferes with another process HIV needs to make copies of itself.

By disrupting these crucial steps, the PrEP drugs deny HIV the means to establish infection and spread throughout the body. Taking the medication daily allows the protective levels to build up over time. This makes PrEP highly effective when used consistently as prescribed.

PrEP Efficacy

Studies clearly show PrEP is highly effective at preventing HIV when taken consistently as prescribed.

Research on men who have sex with men found those who adhered well to daily PrEP cut their risk of getting HIV by over 90%. Among couples where one partner has HIV, the medication lowered transmission by up to 96% for the HIV-negative partner.

PrEP remains highly effective even if some doses are missed. Taking it 4 or more times a week still reduces the chances of getting HIV by over 90%.

These impressive success rates make PrEP one of the most valuable new tools to prevent the spread of HIV. When taken properly, it gives high-risk individuals a safe, reliable way to stay HIV-negative.

Is PrEP Safe?

Clinical trials and extensive real-world experience have shown PrEP medication to be generally safe and well-tolerated. The most common side effects are mild and often resolve on their own over the first month.

Potential early side effects can include headaches, nausea, fatigue and diarrhea. A small percentage of users also experience loss of appetite, insomnia, rash, abdominal pain and bloating. These mild side effects mirror those from the antiretroviral drugs used to treat HIV infection.

Some people taking the drug combination can see a small decrease in kidney function and bone mineral density. However, these effects appear reversible after discontinuing PrEP. No serious adverse events have been observed with long-term use.

While on PrEP, regular medical checkups and lab testing help monitor for any side effects. Healthcare providers also screen for underlying kidney issues or bone loss risks before prescribing PrEP. Appropriate clinical monitoring makes PrEP a safe choice for most people.

Compared to the serious consequences of contracting HIV, the potential side effects of PrEP are relatively minor for most. Still, individuals considering this prevention option should discuss any health concerns with their provider.

PrEP vs. Other Preventive Measures

PrEP provides an extra prevention option to use along with other HIV prevention methods like condoms. Using PrEP together with condoms lowers the risk even further.

Post-exposure prophylaxis (PEP) involves taking HIV medication right after possible exposure, like a condom breaking during sex. PrEP is different - you take it daily before being exposed.

Abstinence, having only one HIV-negative partner, reducing partners, and using clean needles also reduce risk. PrEP gives added protection if someone is unable to use those other methods consistently.

No single approach is 100% effective against HIV. Combining prevention strategies like PrEP, condoms, and regular testing offers the strongest defence for those at high risk.

Key Ingredients of PrEP

PrEP medication contains two main drugs:

  • Tenofovir - This blocks an enzyme HIV needs to make copies of itself.
  • Emtricitabine - This interferes with HIV's ability to duplicate its genetic material.

These are the same drugs used to treat HIV infection. But as PrEP, they work by preventing the virus from spreading in the body.

The pill with both tenofovir and emtricitabine is commonly called Truvada. At The Independent Pharmacy, we offer a generic version of Truvada (a combo of tenofovir and emtricitabine) for people to take to prevent contracting HIV.

There's also a newer version of PrEP with a slightly different form of tenofovir called TAF. Both work well, but the new version might have fewer side effects.

Knowing the key components helps explain how PrEP safely stops HIV from establishing a permanent infection. This knowledge empowers individuals to make informed choices about using PrEP to prevent HIV transmission.

PrEP vs. PEP

PrEP (pre-exposure prophylaxis) is a medicine you take before you might be exposed to HIV, while PEP (post-exposure prophylaxis) is what you take after a possible exposure These two HIV prevention approaches use antiretroviral medication in different ways.

PrEP involves taking the medication daily before potential HIV exposure. It builds up protective levels in the body over time. PrEP aims to prevent infection from occurring in the first place.

In contrast, PEP is meant for emergency situations. It involves starting antiretroviral treatment within 72 hours after suspected HIV exposure, like unprotected sex. Rather than prevent initial infection, PEP aims to stop the virus in its tracks after exposure.

While both use anti-HIV drugs, PrEP provides ongoing prevention for people at high risk. PEP serves as a safety net in case an accident or high-risk event occurs despite precautions. Using PrEP and PEP together can offer comprehensive protection.

Embarking on the PrEP Journey

If you're considering PrEP, some key steps can help you embark on the process confidently and safely.

Assessment and Consultation

The first step is discussing your individual situation with a healthcare provider, like a doctor or sexual health specialist. They will assess your risk factors and need for PrEP. A consultation also covers any health conditions, medications, and safety considerations.

Healthcare providers determine if PrEP is appropriate based on your sexual behaviours, partners, use of injection drugs, and other factors. An open discussion allows for personalised guidance.

You can also buy PrEP from a pharmacy for personal use.

Starting PrEP

If deemed an appropriate candidate, your provider will explain how to take PrEP correctly. The standard regimen is one Truvada pill daily. Knowing the proper way to take PrEP is key to getting maximum protection.

Baseline lab tests for kidney function, HIV, and other stats are needed before starting. Your provider will schedule follow-up visits to monitor any side effects and test for HIV. Many high-risk individuals take PrEP for multiple years.

Embracing Life with PrEP

Once you've started on PrEP, some important habits can help you integrate it into your routine and get the most protection:

Daily Regimen

  • Take your daily PrEP dose at the same time each day to help build a consistent habit. Many people find taking it in the morning or with a meal helps.
  • Consider setting a daily reminder on your phone or watch to prompt you to take your pill. Tools like pillboxes or calendars can also help track doses.
  • Take PrEP every day, even if you don't end up having sex that day. Maintaining daily levels is crucial for protection.
  • If you miss a dose, take it as soon as possible unless it's almost time for the next one. Never double up to make up for missed doses.

Health Monitoring

  • See your healthcare provider every 3 months for HIV testing, lab work, prescription refills, and follow-up.
  • Doctors will test your blood every 6 months to make sure the medicine isn't affecting your kidneys or bones. Report any symptoms like fever or rash.
  • Ongoing monitoring ensures PrEP remains safe and effective. Providers may advise discontinuing PrEP if your risk decreases over time.

Drug Interactions

  • Inform your provider about any new medications, supplements, or vitamins you start taking while on PrEP.
  • Some common medicines, including certain antibiotics and herbs, might not mix well with PrEP. Never take extra doses without medical guidance.
  • Illegal drugs like cocaine, methamphetamine, and erection-enhancing drugs can also interact with PrEP. Be honest with your provider about any drug use.

Your Next Steps With The Independent Pharmacy

Armed with this knowledge and understanding about PrEP, you're not alone on this journey to prioritise and embrace a healthier future. Don't wait - get tested regularly for HIV if you are sexually active. Have open and honest discussions with partners about risks and prevention options. If you may benefit from extra protection beyond condoms, consider starting PrEP.

The Independent Pharmacy can help you access PrEP safely, affordably and discreetly if appropriate for you. All you need to do is to fill in your self-assessment. Our specialists will objectively assess your individual risks and need for PrEP. If eligible, we offer quick, confidential access to PrEP medication and provide ongoing medical support.

From quick ordering to on-demand home delivery, we make it easy to access this powerful prevention option if you could benefit. Contact The Independent Pharmacy today to take the first step or learn more about how PrEP could help safeguard your sexual health.

Answering Your PrEP Questions

Starting PrEP for HIV prevention often brings up many important questions. Here we answer some of the key and most common queries:

Can HIV be completely cured?

While no cure currently exists, early HIV treatment with antiretroviral therapy allows many people to live long, healthy lives and avoid transmitting the virus. Research on curing HIV is ongoing.

How many years can an HIV-positive person live?

With proper treatment and care, HIV-positive people today can have near-normal life expectancies.

What is the most effective HIV treatment?

Combination antiretroviral therapy that suppresses viral levels is the most effective treatment. Taking the medication daily as prescribed is crucial.

Can you have HIV for 20 years and not know?

Yes, it's possible to live with undiagnosed HIV for many years without symptoms. That's why regular HIV testing is so important if you are sexually active.

Is PrEP available on the NHS?

Yes, PrEP is available through the NHS to eligible people in the UK without having to pay.

Sources:

Common questions about Pre-Exposure Prophylaxis (PrEP) - NHS (www.nhs.uk)

About Pre-Exposure Prophylaxis (PrEP) - NHS (www.nhs.uk)

Pre-exposure Prophylaxis (PrEP) for HIV Infection: How Antiretroviral Pharmacology helps to Monitor and Improve Adherence - PMC (nih.gov)

Prevention of HIV-1 Infection with Early Antiretroviral Therapy - PMC (nih.gov)

Exploring the Use of Pre-exposure Prophylaxis (PrEP) for HIV Prevention Among High-Risk People Who Use Drugs in Treatment - PMC (nih.gov)

PrEP (pre-exposure prophylaxis) | Homerton Healthcare NHS Foundation Trust

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