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Tablets to prevent HIV – PrEP

   HHIV PrEPIV Pre-Exposure Prophylaxis – PrEP

In 2010, I wrote a blog article on PrEP which is short for Pre-Exposure Prophylaxis.

Since then, there has been many updates and new research published so it is high time for an updated entry.

Just to recap, HIV PrEP is a medicine that a person takes everyday which reduces his/her risk of contracting HIV. This is not a new concept in medicine. Take for example tablets taken daily to prevent Malaria or tablets taken daily to prevent pregnancy.

This should not be mistaken for PEP which is Post Exposure Prophylaxis. PEP are medicines taken AFTER a person has been potentially infected with HIV.

So what exactly is PrEP?

PrEP is simply a tablet taken daily that reduces a person’s risk of contracting HIV.  It’s that simple. The tablet most studied for use as PrEP contains 2 medicines:  tenofovir disoproxil fumarate 300 mg (TDF) and emtricitabine 200 mg (FTC). This is marketed under the brand name Truvada and is made by a company called Gilead Sciences.

How effective is PrEP?

There have been many studies with varying results. Generally, protection rates differ between groups with different sexual orientations. Numbers range from 50% to 84% according to the 4 studies quoted in the US CDC’s Interim Guidelines. Other publications quote protection rates as high as 99%.

We must bear in mind that like every other method of HIV prevention, PrEP is not failsafe. It is one of the many weapons in our current arsenal to reduce the burden of HIV on the world. Other prevention methods include:

  1. Consistent and correct condom use.
  2. Access to treatment. Treatment as prevention.
  3. Education.
  4. Male circumcision.

What are the side effects of PrEP?

Minor side effects such as nausea, headache and weight loss are possible.

Major side effects like effects on the kidney and bone density are rare.

In my personal experience prescribing PrEP, I have not come across anything more than some minor nausea.

What is the cost of PrEP?

This of course varies from country to country and even between centres in the same country. In our clinic, one bottle of 30 tablets of Truvada costs $900 before GST.

How can I start PrEP?

Come see us at our clinic. You will need several tests including a HIV test, STD screening and a kidney function test.

You can start on the pills immediately. It is best to be on the pills for at least 7 days before engaging in any risky encounters.

How can I stop PrEP?

It is best to continue PrEP for at least 4 weeks from the last risky encounter.

You will also be advised to get screening tests done for HIV and other STDs 3 months from the last encounter.

How long can I take PrEP for?

PrEP can be taken indefinitely and should be taken as long as you remain at risk of HIV.

It is best to see your doctor every 3 months to screen for HIV and STDs and monitor for potential side effects.

For further reading:

My PrEP Experience Blog is a great resource on everything you need to know about PrEP.

It also contains real life stories from patients who have taken PrEP and their experiences. I highly recommend that you check it out if you are considering starting on PrEP.

PrEP can save your life. Visit Our Clinics now and talk to Our Doctors to see if you are suitable for PrEP.

If you had a high risk exposure to HIV within the past 72 hours, you can take medicines to reduce your risk of actually contracting HIV. Find out more on HIV PEP Treatment.

 

advise


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About Dr. Tan
Dr. Tan graduated from the National University of Singapore in 2001. His residency was in the two largest public hospitals in Singapore; Tan Tock Seng Hospital and Singapore General Hospital.

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7 Comments

  1. Elsabella Wong (Singapore Polytechnic)

    Dear Dr Tan

    I am a student research studying Applied Drama and Psychology in Singapore Polytechnic. A project that I am currently working on involves research and contact with sex workers. As you might have guessed, they perform highly risky sexual behaviours on a daily basis, therefore their risk of contracting HIV is high.

    I stumbled across PrEP while searching for a viable solution to reduce the risk. However, little did I know that PrEP costs $900 per bottle. I believe this is deemed high and may deter the sex workers from buying Truvada.

    May I know, in your opinion, if there are some other ways to procure Truvada at an affordable price? Or perhaps if there are already hospitals and mobile clinics offering this treatment at a discount?

    Thank you very much for reading through this comment. Have a great day ahead.

    Yours sincerely
    Elsabella Wong

    • HI Elsabella. It is nice to see our young millenials tackling problems some people would consider morally stigmatising. Kudos to you.

      First of all you may want to verify your data. You sure the risk of commercial sex workers contracting HIV in Singapore is high? What publications are you quoting?

      Secondly, PrEP is not effective across the board. Data has shown that PrEP is less effective for women compared to gay men. So the risk benefit ratio for female CSWs taking PrEP may not be that good.

      A common way people in Singapore get cheap Truvada is simply to buy it from Thailand. There are ways to get it cheaply in Singapore but that is not for discussion over the internet.

      I would like to invite you to attend the Singapore AIDS conference to be held on 3rd December 2016. We will be discussing the use of PrEP.

      • Elsabella Wong (Singapore Polytechnic)

        Dear Dr Tan

        So sorry for the late reply. I was quite deep into my research as compared to before and was not expecting a reply soon. Thank you for taking the time and effort to reply to a random student asking questions on the internet.

        As for the data, I have none but I did read the article you posted 2 years ago targeting commercial sex in Singapore and as you may have speculated (based on the evidence you have), regulated sex workers have a lower risk of contracting HIV as compared to streetwalkers as they go through regular screenings.

        I am currently working on a proposal to benefit the unlicensed Sex Workers and it is impossible to find any sort of relevant data on them. Therefore, I am unable to conclude whether they do have a higher risk of contracting HIV. However, I did reach out and spoke to the director of Project X (Vanessa Ho), the only NGO focus on fighting for Sex Workers’ Rights.

        I asked her for her opinion on PrEP and she embodied similar sentiments as you did, fearing that the side effects of PrEP could cause more harm than good.

        Hahaha! Yeah. Those discussions on ways to procure cheaper alternatives would be best left for private conversations over dinner.

        I would love to attend the Singapore AIDS conference held on 3rd December. What would be the best way to do so? Where do I sign up?

        Once again thank you Dr Tan for reading through this long message! Hope I hear from you soon.

        Yours sincerely
        Elsabella Wong

  2. condom broke csw 3,4,8,9 weeks rapid antibody blood test then at 12 weeks and 94 days rapid 4th generation duo. Since my last duo test I’ve had swollen lymph nodes by my groin and feels like im losing weight. I’m starting to freak out again do this mean that I’m one of those rare case that have to wait 6 months to get a positive result. I also found out I had chlamydia from this woman 8 week post exposure so I’m wondering did I catch hiv to i been to my doctor he thinks it syphilis that make me even more scared because I had a full std screening at 3 weeks post exposure so why wouldn’t it show then. I don’t have any immune deficiency nor cancer what’s goin on doc.

    • I do not think your symptoms are related to HIV given the test results. You may want to get yourself checked by a doctor again, and repeat a STD screening.

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