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PrEP (Pre-Exposure Prophylaxis)

a bottle of pills

Pre-exposure prophylaxis (PrEP) is a course of HIV drugs taken before sex to reduce the risk of getting HIV. It could one day be widely available to those who are at high risk of coming into contact with the virus.

  1. What is PrEP?
  2. In what circumstances would someone take PrEP?
  3. Why do we need PrEP?
  4. Why is Terrence Higgins Trust advocating for PrEP?
  5. Who can access PrEP now and in the future?
  6. Why is PrEP only available for certain groups?
  7. How can I access PrEP?
  8. When will PrEP be available outside the trial?
  9. How effective is PrEP?
  10. Is PrEP equally effective for all groups?
  11. Is PrEP an option for everyone?
  12. Do I have to take PrEP every day?
  13. How long will I have to take PrEP for?
  14. Can I stop taking PrEP at any point?
  15. Will PrEP encourage more risk taking and less condom use when engaging in sexual activity?
  16. Is PrEP regarded as safer sex?
  17. Why give people HIV medication before they need it?
  18. Why prescribe a daily course of powerful medication only to prevent someone having to take medication in the future?
  19. Why would people who are not living with HIV want to take medication possibly every day?
  20. Will taking PrEP result in developing resistance to antiretroviral treatment?
  21. Are there any side-effects from taking PrEP?
  22. What are the long term effects from taking PrEP?
  23. How much will it cost?
  24. How can people get more advice about PrEP?

What is PrEP?

Pre-exposure prophylaxis (PrEP) is a course of HIV drugs taken before sex to reduce the risk of getting HIV. The idea is that it could one day be widely available to those who are at high risk of coming into contact with the virus.

In trials HIV negative people have been given HIV drugs in the hope that this will stop them contracting HIV if they have unprotected sex with someone living with HIV. Results in trials have been promising, with PrEP significantly lowering the risk of becoming HIV positive and without major side effects.


In what circumstances would someone take PrEP?

PrEP is intended for people who are at high risk of getting HIV. This would include those in a relationship with an HIV positive partner or people who have many sexual partners but find it very hard to use condoms.


Why do we need PrEP?

PrEP is needed as an additional means of HIV prevention, protecting those at highest risk from acquiring HIV. This would help to reduce the spread of HIV and thus the number of new transmissions each year.

As there are now over 100,000 people living with HIV in the UK, we still need to improve HIV prevention. 


Why is Terrence Higgins Trust advocating for PrEP?

Terrence Higgins Trust is advocating for PrEP because it has the potential to prevent new infections among some of those at greatest risk of acquiring HIV. Tens of thousands of HIV transmissions have been prevented by condom use. However, many people do not use condoms all of the time, and each year there are thousands of new infections.

Due to the ongoing rate of HIV transmissions, we believe that any tool to prevent onward transmission should be used if it is cost effective. PrEP would be an additional prevention tool. It is not appropriate for everyone and it should be part of a range of options. 


Who can access PrEP now and in the future?

PrEP has only been available to people enrolled in a research trial taking place in six cities in the UK, but it has been available in the USA since 2012.

PrEP is not available through the NHS on prescription. In May 2016, following a series of setbacks and u-turns, NHS England shelved plans to make PrEP available on the NHS. We remain committed to making PrEP available to those who need it, and are still calling on the NHS to make Pre exposure prophylaxis available to those people who are most at risk of getting HIV.. You can add your name to the petition

Since August 2015, PrEP has been offered through a private service where a prescription may be purchased following an assessment.


Why is PrEP only available for certain groups?

PrEP has only been available through a research trial which focused mainly on gay and bisexual men who have sex with men, as well as a small number of trans women. However, PrEP can now be obtained through a private service where a prescription may be purchased following an assessment.


How can I access PrEP?

In the UK, PrEP has only been made available to people enrolled in a research trial. In May 2016, following a series of setbacks and u-turns, NHS England shelved plans to make PrEP available on the NHS. However, a private PrEP service is now available where a prescription can be purchased following an assessment.


When will PrEP be available outside the trial?

In May 2016, following a series of setbacks and u-turns, NHS England shelved plans to make PrEP available on the NHS, stating that it was not their responsibility to commission the drug.

We remain committed to making PrEP available to those who need it, and are still calling on the NHS to make Pre-exposure Prophylaxis available to those people who are most at risk of getting HIV.

Since August 2015, PrEP has been offered through a private service where a prescription may be purchased following an assessment.


How effective is PrEP?

Research suggests that PrEP is highly effective in preventing HIV transmission, as long as the pills are taken as directed.

In a large international study, gay men who took at least four doses a week had 96 per cent fewer infections. Results from separate studies of PrEP in the UK and France have both showed that PrEP substantially reduces infections among gay men. The UK study reported that there was an 86 per cent reduction in the rate of HIV infection when PrEP was made available.

PrEP has also proven effective for heterosexual couples in which one partner is HIV positive. 


Is PrEP equally effective for all groups?

To date, there have been variable results in some groups. However, not all groups have been fully studied and so effectiveness cannot be determined. 


Is PrEP an option for everyone?

No. PrEP will not be suitable for everyone. People who are not at high risk of exposure to HIV would not need to take PrEP.

The medication may also cause side effects which may cause some people to decide not to continue with the treatment, therefore PrEP would not be an option for them. 


Do I have to take PrEP every day?

It is recommended that you take PrEP as directed by your clinician. Normally this involves taking one pill on a daily basis.

However, a recent French study has demonstrated that taking two pills in the 24-hour period before anticipated sex and then two separate one-pill doses in the two days after sex is effective in providing protection against HIV. 


How long will I have to take PrEP for?

It is recommended that you take PrEP as directed by your clinician. Normally this would involve taking one pill on a daily basis while you are engaging in higher risk sexual activities that increase your risk of HIV.

If your situation changes, such as entering into a long-term relationship, then you may wish to stop taking PrEP. It is best to discuss any changes with your clinician. 


Can I stop taking PrEP at any point?

Yes. PrEP can be stopped at any point but this will affect protection against HIV.

Your situation may change and therefore it might be appropriate to stop treatment – such as starting a new relationship with a partner who has an undetectable viral load or who is HIV negative. It is best to discuss stopping taking PrEP with your clinician. 


Will PrEP encourage more risk taking and less condom use when engaging in sexual activity?

Most studies of PrEP have consistently reported that being on PrEP did not result in people adopting more risky behaviours or reduced condom usage.

In the UK, the PROUD study has provided strong evidence that the use of PrEP made no difference to risky behaviours. First, the levels of other STIs were almost the same in the group given PrEP and the group who did not have the drug. Second, levels of condom use were almost the same in both groups. Thus PrEP gives people who already find it difficult to consistently use condoms a way to protect their health, rather than changing their sexual behaviour significantly. 


Is PrEP regarded as safer sex?

Research has suggested that PrEP is highly effective at preventing HIV as long as it is taken as directed.

However, it does not stop the transmission of other sexually transmitted infections. Condom use is still proposed as an effective means of protection against HIV, STIs and pregnancy. 


Why give people HIV medication before they need it?

The purpose of PrEP is to provide protection for HIV negative people engaging in higher risk sexual activities. PrEP consists of fewer drugs than the treatment given to those living with HIV and people only need to take it during periods when they are at risk of HIV. Much like protection against malaria, the emphasis is on pre-exposure treatment. 


Why prescribe a daily course of powerful medication only to prevent someone having to take medication in the future?

People living with HIV need to take lifelong treatment. PrEP consists of fewer drugs and people only need to take it during periods when they are at risk of HIV.

Many people find that their sexual behaviour changes over time, for example when they begin or end a relationship. PrEP has been found to be effective for high risk groups and may prove cheaper than treating HIV-related conditions in the long term. 


Why would people who are not living with HIV want to take medication possibly every day?

People make their own decisions as to whether to take medication or not. Some may feel that taking medication is acceptable because they find consistent condom use difficult and PrEP has been found to reduce the risk of HIV.

It also allows people to take responsibility for their own sexual health rather than relying on another person to disclose their HIV status and/or negotiate safer sex. 


Will taking PrEP result in developing resistance to antiretroviral treatment?

Concerns have been expressed that the use of PrEP may lead to the spread of resistance, following data from animal studies. However, a recent study has suggested that resistance is only likely if someone has contracted HIV at around the same time they start taking PrEP. This is because Truvada must be used in conjunction with other HIV medication to treat the infection. 


Are there any side-effects from taking PrEP?

Many medicines can have side-effects, so taking PrEP is a considered decision. The drugs in PrEP have been used as part of HIV treatment for many years. Evidence over the years has shown that they have a low risk of serious side-effects.

Most people taking PrEP do not report side-effects. Some people have stomach problems, headaches and tiredness during the first month but these usually go away.

People taking PrEP have regular check-ups at a clinic, where they will be tested to ensure any side-effects are assessed. 


What are the long term effects from taking PrEP?

The long term effects from taking PrEP are not understood fully as yet, as most clinical trials only take place over a few years.

Reductions in bone mineral density and kidney health have been reported in some HIV positive people taking Truvada as part of their long term treatment for HIV. However, this may result from the virus itself. 


How much will it cost?

We do not know the full cost yet but but the drug itself costs around £360 per month. However, it will be cheaper than providing treatment to someone living with HIV. 


How can people get more advice about PrEP?

If you would like to know more about PrEP please call THT Direct on 0808 802 1221.


‹‹ Back to: PEP - Post-exposure prophylaxis

 

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The Information Standard: Certified member

This article was last reviewed on 6/6/2016 by Anna Peters

Date due for the next review: 6/6/2019

Content Author: Clive Blowes

Current Owner: Daisy Ellis

More information:

Pragmatic Open-Label Randomised Trial of Pre-Exposure Prophylaxis: the PROUD study, PROUD, MRC Clinical Trials Unit & Public Health England, February 2015

HIV in the United Kingdom: 2014 Report, Public Health England, November 2014

PROUD study interim analysis finds pre-exposure prophylaxis (PrEP) is highly protective against HIV for gay men and other men who have sex with men in the UK, PROUD, MRC Clinical Trials Unit & Public Health England, October 2014

Second European PrEP study closes placebo arm early due to high effectiveness, Gus Cairns, NAM aidsmap, October 2014

Risk of Drug Resistance Among Persons Acquiring HIV Within a Randomized Clinical Trial of Single- or Dual-Agent Preexposure Prophylaxis, The Journal of Infectious Diseases, March 2014

Next steps for PrEP: Getting a proven prevention option to the people who need it, Deirdre Grant and Kay Marshall, Treatment Issues, June 2013

An Angle on Long-Term Side Effect Risk With TDF/FTC PrEP in Weighing Risks of TDF/FTC PrEP Side Effects in People Without HIV, Mark Mascolini from The Center for AIDS, The Body Pro, Winter 2012

Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men, Anderson PL1, Glidden DV, Liu A, Buchbinder S, Lama JR, Guanira JV, McMahan V, Bushman LR, Casapía M, Montoya-Herrera O, Veloso VG, Mayer KH, Chariyalertsak S, Schechter M, Bekker LG, Kallás EG, Grant RM; iPrEx Study Team; Science Translational Medicine, September 2012

Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women, The New England Journal of Medicine, August 2012

PrEP Works... If You Take It, PrEP efficacy table from www.prepwatch.org

PROUD study website

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