Pre-Exposure Prophylaxis (PrEP)

What is PrEP (pre-exposure prophylaxis?)

PrEP is a medication taken in cases where there is a likelihood that a person may come into contact with a carrier of the infection and become infected themselves. Those in the higher risk category may include those who are:

• having sex with someone who is HIV positive
• having intercourse with someone from countries with high levels of HIV
• taking drugs through the use of needles and sharing needles
• sex workers
• regularly having sex without condoms

When taken daily, the presence of these two drugs in the bloodstream can prevent HIV from being able to establish itself and spread throughout the whole body. This is why PrEP must be taken daily to keep the levels of the drug high enough to work effectively.

Note: Although the drugs used are separate treatments for HIV-1, together they do not form a complete HIV treatment. As such, if you are HIV positive, you must take other medications too, and this should be discussed with your GP or Click Pharmacy doctor.

PrEP Prevention rate

The prevention rates from PrEP protecting against HIV infection from sexual intercourse are very positive, so long as the medication is taken consistently. As yet there are limited studies done on occasional use; as such, the FDA highly recommended that PrEP is used every day to ensure the highest level of protection and prevention possible.

Studies rates are published as follows:

• When taken seven days a week, the level of protection is 99%
• When taken four times a week, the security is 96%
• When taken twice a week, this drops to just 76%

Note: if your partner has HIV with an undetectable viral load, i.e. there is so little of the virus in the blood that it cannot be identified through tests, then it is unlikely you will require PrEP as the infection cannot be transmitted in such cases. Speak to your doctor about this if you have any concerns.

In instances when PrEP is used to prevent the infection of HIV in those injecting drugs, the risk is reduced by at least 74%

What’s the difference between PrEP and PEP?

PrEP is the medication to be taken before potential exposure to the virus known as HIV, to stop it from becoming established in your body. Anyone who consistently has sex with an HIV positive partner, has been diagnosed with an STD in the last several months, regularly fails to use condoms, has had multiple courses of PEP, or else anyone who injects drugs alongside an HIV positive partner should consider taking PrEP as a form of protection. In some cases, it can potentially be taken to stop a woman from catching HIV while trying to conceive with an HIV positive partner, or while pregnant or breastfeeding. However, this must be discussed with your doctor beforehand.

PEP, on the other hand, is to be taken after possible exposure to the virus has occurred. If it is likely, you could have come into contact with HIV, and then PEP can be made in an emergency within 72 hours of exposure. Known as post-exposure prophylaxis, the drug is generally taken twice a day for 28 days, and every hour you wait, post-exposure, counts. As such, if you fear you have been exposed to it, then beginning a course of PEP as soon as possible is crucial. It may be beneficial for anyone who has been exposed to HIV during sex, shared a needle with someone who is HIV positive or has been sexually assaulted. You can book a private appointment with one of the doctors from Click Pharmacy to discuss your course of action at any time.

How does PrEP work?

HIV is known a retrovirus, meaning it has a reverse enzyme transcriptase, or HIV enzyme, which allows it to convert its genetic material into DNA matching its ‘host’. It then uses that copied DNA to enter and infect the cells of the person in question. PrEP works by blocking this enzyme, thus preventing the virus from making copies of itself within the body and spreading.

When used alongside methods of safe sex such as condoms, it is a highly effective way of protecting the body from infection. It is important to note that it cannot protect against other STIs or pregnancy.

Can I buy PrEP treatment online?

Click Pharmacy is a registered online pharmacy and doctor service; as such, you can arrange an online appointment if you prefer or else complete the health questionnaire which will be assessed by one of our in-house experts. Once approved, your prescription will be generated, and you can purchase PrEP and have it sent directly and discreetly to your chosen address.

How long does it take for PrEP to become active?

It is advisable that when beginning the PrEP treatment that you leave at least seven days before possible exposure to allow the drug to reach high enough levels for protection.

Who should not take PrEP?

PrEP is not to be taken after possible exposure to HIV has occurred as it will not be effective in reducing your chances of developing the virus. Neither should it be used by those who are already diagnosed as HIV positive. Before beginning the treatment, you will likely be asked to take a test to ensure you are HIV negative.

You do not need to take PrEP if you are happy to wear a condom every time you have sexual intercourse. Neither should the drug be accepted without a doctor consultation if you are also taking medication which affects the kidneys such as non-steroidal anti-inflammatories (NSAIDs) including ibuprofen.

Patient Information Leaflet

Always read the patient information leaflet before starting your treatment.

How effective is PrEP?

PrEP is highly effective, provided you take it according to instructions. It can be as high as 99% effective against HIV transmission and even more if taken with a condom during sex. For people who share needles, PrEP can be up to 70% effective against HIV transmission.

Do you need an HIV test before PrEP?

Yes, you need an HIV test before taking PrEP. It is only suitable for HIV-negative people. If an HIV-positive person takes it, they will develop resistance against the included drugs. As these are the same drugs used to treat an active HIV infection, the response to treatment will be poor for an HIV-positive individual.

Can you buy PrEP over the counter?

It may not be possible to purchase PrEP over the counter. You may need a prescription to buy it.

How long should you take PrEP for?

You can take PrEP as needed for weeks, months or even years. It is not necessary to take it for life.

Side effects of PrEP

A few common side effects include

• Depression
• Fatigue
• Bloating
• Dizziness
• Headaches
• Nausea
• Diarrhoea

These side effects are rarely serious and usually disappear within a few weeks of using PrEP. However, if they persist, you should discuss them with your doctor.

Kidney damage is one of the more serious side effects, but it is infrequent. However, it is possible if you already have kidney disease or take drugs that impact your kidneys.

Can you prevent the contraction of HIV?

HIV contraction can be prevented by abstinence, using condoms, having limited sexual partners, getting tested for STDs and using Pre-Exposure Prophylaxis (PrEP). Once someone contracts HIV, the virus will remain in the body indefinitely, even with treatment. You may not have symptoms for extended periods. The disease is manageable and doesn’t necessarily result in AIDS in all people.

How is HIV transmitted?

HIV is transmitted through sexual contact with an infected person via bodily fluids, including blood, breastmilk, semen and vaginal fluid. It is not transmitted by close proximity, sharing toilet, dishes etc. and casual contact. It cannot pass through sweat, saliva, urine, tears or by mosquitos.

What tests do I need before I can start PrEP?

The following tests are necessary before starting PrEP

• Test for HIV
• Kidney function tests
• Test for Hepatitis B (in case you are not vaccinated)
• Test for Hepatitis C (for trans women and homosexual men)

How do I take PrEP?

You should take PrEP daily at the same time every day, with food. Protection will begin after

• 4 days for anal sex
• 7 days for vaginal sex

Does PrEP interact with other drugs or alcohol?

Some drugs may reduce the efficacy of PrEP if taken along with them. These include

• Some antifungals and antivirals
• Some antibiotics
• Some painkillers
• Medication for treating Hepatitis C
• Cancer drugs

Alcohol is not known to cause interactions with PrEP, but you should only take recommended units of alcohol per week to keep the liver healthy.

Can PrEP cure HIV?

There is currently no known cure for HIV. HIV is managed by using special antiviral drugs. They help infected people live a long and healthy life. PrEP lowers the risk of getting HIV infection if taken correctly. The use of a condom is still recommended, along with PrEP.

Can PrEP be used as PEP?

Post-exposure prophylaxis, or PEP, is different from pre-exposure prophylaxis or PrEP. PEP is taken after having sex if there is a chance that you are exposed to HIV. It should be taken immediately after sex and is usually prescribed for a month after exposure.

Can PrEP prevent other STIs?

PrEP does not prevent other sexually transmitted infections or STIs. Therefore, other protection methods, such as condoms, should be used. STIs include diseases like syphilis, herpes, chlamydia or gonorrhoea.