PrEP is a modern method of preventing HIV infection. Little is said in Poland about this type of prevention. At the same time, it is extremely effective in the case of people who are particularly exposed to contact with the virus. It reduces the risk of infection by up to 99%. What is this type of prophylaxis about? How do I start using PrEP? Who is this method for?

What is PrEP?

Pre-exposure prophylaxis (PrEP) is the use of drugs to prevent disease in people who have not yet been exposed to the virus responsible for them. Typically, the term is used to refer to the specific pharmacological strategy used to prevent HIV and, consequently, AIDS. For this reason, in order to facilitate the understanding of the content, the term "PrEP" will refer to this type of prophylaxis later in the article.

During PrEP, a person exposed to the virus takes antiviral medications before taking any risky action that could lead to infection. It is recommended that people under pre-exposure prophylaxis take a small dose of the active ingredient every day, at regular intervals.

When used as recommended, PrEP has been shown to be highly effective. It is estimated that it reduces the risk of contracting HIV by up to 99%. These data, however, are adequate for the conditions in which clinical trials are conducted. In the case of a patient taking medications as prescribed by a doctor, an effectiveness in the range of 86-96% is given.

Who is pre-exposure prophylaxis for?

PrEP is a pharmacological HIV prevention strategy for people at higher risk of contracting the virus. Pre-exposure prophylaxis is not a method for everyone. Its use is associated with a certain burden on the body. Therefore, before starting this prophylaxis, the risk of possible infection should be assessed.

Patients who should use PrEP include:

  • sexually active people engaging in risky behavior, e.g. not using a condom while having sex with an HIV-positive person
  • patients recently diagnosed with sexually transmitted diseases
  • men having sex with men (MSM- abbreviationused later in this article), engaging in risky behavior
  • people who engage in sexual contact after taking psychoactive substances
  • injecting drug users
  • sexually active couples if one of them is HIV positive

WHO recommendations on PrEP

In 2012, the World He alth Organization (WHO) published guidelines for PrEP. The original recommendations concerned the use of this type of prophylaxis among men and transgender women who have sex with men.

The WHO updated these recommendations in later years. Ultimately, the organization concluded that PrEP is recommended as an additional choice in HIV prevention as part of a comprehensive approach to HIV prevention. 4 In November 2015, the WHO extended its recommendations based on evidence of the method's effectiveness. Currently, pre-exposure prophylaxis is recommended for all population groups at high risk of HIV infection.

WHO recommendations on PrEP

The World He alth Organization (WHO) recommends two drug combinations for use as PrEP from 2022. The first is tenofovir plus emtricitabine, the second is tenofovir plus lamivudine.

In Poland, tenofovir and emtricitabine are usually used combined in one tablet. It is a simple and convenient form of drug administration for the patient. These substances work by blocking one stage of the HIV replication cycle. As a consequence, they make infection more difficult.

What medications are used during PrEP?

Avoiding chronic virus infection requires taking medication according to guidelines. Irregular intake of therapeutic substances can lead to too little concentration in the body. As a consequence, levels of the drug may be too low to prevent HIV infection. For this reason, it is important to take one tablet of the preparation every day at the same time.

Clinical studies show that protection against infection by MSM anal contact is possible after 7 days of medication use. In the case of women undertaking risky sexual relations with men and intravenous drug use, the prophylactic effect is achieved after 20 days.

The physician in charge of PrEP in a patient at risk of infection should check that he or she is taking medication regularly. In the event of improper use of the preparation, a psychological consultation is recommended in order to solve the problem that hinders effective prevention.

The cost of monthly pharmacological prophylaxis is about PLN 130, excluding the costs of private visits to a doctorspecialist and required tests.

Starting PrEP requires a lot of lab testing. One of them is testing the presence of HIV in the patient's body. After the start of prophylaxis, the patients are constantly monitored by the attending physician.

Visits to a specialist should take place every three months, although a six-month break is allowed. They are related to monitoring the condition of the person using PrEP.

Your doctor may recommend an HIV test again after some time.

Other studies carried out are:

  • tests for sexually transmitted infections
  • kidney function control
  • pregnancy test

It is worth noting that PrEP is not a 100% effective method in preventing HIV infection, even in people who take medication as prescribed.

How does PrEP start?

The first step in starting PrEP is to make an initial visit to a specialist physician. Before undertaking this type of prophylaxis, it is necessary to exclude HIV infection or other sexually transmitted diseases. The patient should also be vaccinated against HBV and HAV.

The doctor's job before starting PreEP is to inform the person concerned about the risk of sexually transmitted diseases other than HIV. The specialist should also make the patient aware of the need for regular examinations during prophylaxis and the importance of taking medications in accordance with the guidelines.

Also required:

  • determination of creatinine concentration
  • blood count
  • urine general examination

PrEP and other forms of security

Since PrEP is not 100% effective in preventing HIV and does not protect against certain STIs, the use of condoms is recommended while using PrEP.

Condoms, if used correctly, will protect against:

  • HIV
  • syphilis
  • with gonorrhea
  • chlamydiosis
  • and other sexually transmitted diseases

Clearly, PrEP does not protect against unwanted pregnancies. For this reason, women taking this type of pharmacological infection prophylaxis should also use effective contraception.

PrEP side effects

Research has shown that PrEP is a highly secure method. This type of prophylaxis is usually well tolerated by patients. Of course, just like taking any other type of medication, it does come with someside effects.

Some patients experience unpleasant symptoms when initiating prophylaxis. They include nausea, headache, and stomach problems. These problems usually go away within a few weeks of starting PrEP.

Social benefits of PrEP prophylaxis

High prevalence of pre-exposure prophylaxis among groups particularly exposed to HIV infection reduces its prevalence in the population. This is extremely beneficial as the risk of contracting this virus for the average person drops.

The PrEP method forces people who engage in risky sexual behavior to undergo regular checkups. This type of monitoring limits the development of sexual diseases in patients, and thus their spread by infecting partners.

An example of such a correlation can be the "Getting to Zero" campaign initiated by the city of San Francisco. It was aimed at drastically reducing the number of new HIV infections. The main activities were to extend access to PrEP.

Public He alth officials say that since 2013, the number of new HIV infections in the city has decreased by nearly 50%. This effect is associated with the campaign.

Professional medical facilities you can report to to start PrEP

About the authorSara Janowska, MA in pharmacyPhD student of interdisciplinary doctoral studies in the field of pharmaceutical and biomedical sciences at the Medical University of Lublin and the Institute of Biotechnology in Białystok. A graduate of pharmaceutical studies at the Medical University of Lublin with a specialization in Plant Medicine. She obtained a master's degree defending a thesis in the field of pharmaceutical botany on the antioxidant properties of extracts obtained from twenty species of mosses. Currently, in his research work, he deals with the synthesis of new anti-cancer substances and the study of their properties on cancer cell lines. For two years she worked as a master of pharmacy in an open pharmacy.

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