Tablets to prevent HIV – PrEP
HIV 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:
- Consistent and correct condom use.
- Access to treatment. Treatment as prevention.
- 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.
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.
Need more advice?
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6.) Katong – (Opening soon)
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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.
About Dr. Tan