PrEP stands for Pre Exposure Prophylaxis. PrEP is an antiretroviral medication that is taken by HIV negative people to prevent HIV infection. Studies from around the world have shown that if taken daily, PrEP works.
PrEP is a very effective HIV prevention tool. It is an exciting medical advancement for anyone who might be at high risk of acquiring HIV. Among heterosexuals, PrEP might be a suitable prevention tool for partners of HIV positive people. While studies have proven that HIV treatments prevent a HIV positive person from transmitting the virus to their partners, we recognise that PrEP may play a role in decreasing anxiety around sex and intimacy for people in serodiscordant relationships.
Like any medication, the decision to start taking PrEP should be an informed decision that is made in consultation with a clinician. See the information below to learn more about PrEP and to find out more about how to access to PrEP in NSW.
1.What does PrEP stand for?
PrEP stands for Pre Exposure Prophylaxis.
2.What is PrEP?
PrEP is a new HIV prevention method in which people who do not have HIV take a pill daily to reduce their risk of acquiring HIV.
3.How well does PrEP work?
Research in other countries has shown that people who take PrEP have a reduced chance of acquiring HIV. How well PrEP works depends on how good people are at taking PrEP every day. There have been six studies in heterosexual men and women which showed a significant reduction in their risk of contracting HIV when people took PrEP every day.
The TDF2 Study found that among heterosexually active men and women who did not have HIV, PrEP reduced the risk of HIV transmission by 62%. Note that the risk reduction of 62% is a population level estimate. What this means is that a whole group of people who took PrEP were 62% less likely to acquire HIV by comparison to another group of people who did not take PrEP. In the group of people who were prescribed PrEP not everyone took their PrEP as directed. In the group of people who were prescribed PrEP and took it every day they were far less likely to become HIV positive.
The Partner Study involved men and women in heterosexual relationships in which one partner was positive and the other negative. The HIV negative people in these couples were prescribed PrEP and they were 75% less likely to get HIV by comparison to the HIV negative people who were prescribed a placebo. Note that among the HIV negative people who actually took their PrEP frequently, they were protected from HIV by 90%.
4.How does PrEP work to protect against HIV transmission?
For PrEP, we know that if the drug is present in the bloodstream and vaginal and/or rectal tissues when someone is exposed to HIV, then the virus will not be able to establish itself and transmit to that individual. PrEP stops HIV from replicating so the virus is not able to establish itself in the body.
5.Who should take PrEP?
The effectiveness of using HIV antiretroviral drugs as PrEP has been established by clinical trials conducted in heterosexual adults, gay men and injecting drug users. PrEP can be considered for people in these populations who are HIV negative but at high risk of acquiring HIV. Among heterosexual people in Australia, PrEP might be a suitable prevention tool for a HIV negative person who is in a relationship with someone who is HIV positive. Or for a woman who is trying to conceive and is in a relationship with a HIV positive man.
6.If I am trying to conceive and my partner is HIV positive, should I take PrEP?
PrEP has been used safely and with success in couples wanting to conceive. For women trying to become pregnant while using PrEP it is recommended that you start taking daily doses of PrEP once month before a conception attempt and continue until one month after the last attempt to conceive. It is strongly recommended that you speak with your clinician or a HIV paediatric service if you want to conceive and take PrEP.
7.If my partner is HIV positive but they are on treatment and they have an undetectable viral load, should I still take PrEP?
There is strong evidence to suggest that a person who is HIV positive but with an undetectable viral load is very unlikely to pass on HIV. In 2011 the HPTN052 study found that starting HIV treatment early reduced the risk of a HIV positive person transmitting the virus to their HIV negative partner by 96%. This finding in relation to heterosexual couples was later mirrored by studies which examined homosexual couples.
Because treatment is so effective at preventing onward transmission of HIV, someone who is in a relationship with a HIV positive person on effective treatment, is not considered to be at high risk of acquiring HIV and therefore it would not always be recommended that they start taking PrEP. However some people who have partners with an undetectable viral load often still consider other ways of protecting themselves against HIV. For neg/pos couples PrEP may be a prevention tool that reduces anxiety and enables a greater sense of security and intimacy within a relationship.
8.Do I have to test for HIV before I start taking PrEP?
It is essential that you have an HIV test before beginning PrEP and if you decide to take it, you need to continue to test for HIV and other sexually transmissible infections on an ongoing basis – at least every three months. Your doctor can also give you advice about any other monitoring that may be required.
9.If I start taking PrEP do I need to worry about side effects?
Truvada and the generic PrEP medicine which contain the same ingredients (TDF/FTC) are generally very well tolerated and most of the potential side effects are quite mild. A minority of people may experience mild symptoms such as nausea, headaches and fatigue. If this occurs, symptoms mostly disappear after the first few weeks on PrEP. In a minority of cases, some have experienced more severe side effects. If at any stage you are concerned that you may be experiencing side effects from taking PrEP, you should contact your clinician.
Long term PrEP can place added stress on your kidneys and liver, for this reason these organs need to be monitored while taking PrEP. If you have existing kidney, liver or bone problems such as osteoporosis, or are taking any other medications, speak to your clinician about whether taking PrEP is the right choice for you.
10.If I am taking PrEP, how often do I have to take it?
It is recommended that you take PrEP once a day, every day. Every PrEP study to date has shown that people who took PrEP once a day every day, experienced greater protection against HIV in comparison to those who did not take their PrEP every day.
11.What if I miss a dose or occasionally forget to take PrEP?
If you miss a dose of PrEP, don’t panic. Resume taking your pills as soon as you remember. It is not recommended to double dose on PrEP to make up for missed doses. If you consistently miss doses, you may lose some of the protective benefits of taking PrEP. If you miss two days of PrEP in a row it will take seven days of taking PrEP daily before you are again protected at a substantial level.
12.If I am on PrEP should I keep using condoms?
When PrEP is taken daily it is highly effective in preventing HIV transmission and gives protection against HIV transmission that is comparable to condoms, although it is not a guarantee against infection. Using condoms will be a choice for you and your sexual partners or partner. However, it is important to remember that PrEP does not prevent the transmission of other STIs. If you do not use condoms, it is important to test regularly and treat STIs if you acquire them.
13.Does PrEP start working immediately?
It takes time for PrEP to build up to levels in your body that are considered protective. The exact length of time is still not clear and is being investigated.Data from studies have shown that protection is achieved after 7 days for rectal tissue, however for full protection to be achieved in blood and vaginal tissue it will take 20 days.
To be on the safe side you should assume that you aren’t getting maximum protection until at least 20 days after you begin taking PrEP, if you take it consistently without missing any pills. This is recommended for all people taking PrEP.
How to Access PrEP
EPIC-NSW is a study run by the Kirby Institute, in collaboration with a number of partners, which aims to assess the impact of the rapid expansion in access to PrEP amongst those at high risk of acquiring HIV. The trial will enrol 3 700 people, these people will receive PrEP free of charge for a 24 month period.
Please note that partners of HIV positive people who are on treatment and have an undetectable viral load, are not considered high risk for HIV and therefore would not be deemed eligible for the EPIC-NSW study.
For more information on the EPIC-NSW study, visit the Ending HIV website here. endinghiv.org.au/nsw/stay safe/epic
Other PrEP Access Options
For those who would like to access PrEP but are not eligible for the EPIC-NSW study there are other options.
For more information, please download this resource which explains your options for obtaining PrEP through the Australian health system, and how to go about obtaining generic Truvada via the internet if you and your doctor decide that is your best access option: (PrEP – Access Options). endinghiv.org.au/nsw/stay-safe/prep/
More Information on PrEP
The Australasian Society of HIV Medicine has posted the Australian National PrEP Guidelines on the (ASHM ARVG website.) arv.ashm.org.au/arv-guidelines/prep-resources-for-clinicians
For more information on importing medicines for personal see the (Australian Government’s Therapeutic Goods Administration TGA) website.) tga.gov.au/importing-mail-or-courier
Living Positive Victoria has produced a resource to assist people with HIV to talk to their friends and partners about PrEP which is on (their website.) livingpositivevictoria.org.au/living-with-HIV/pep-and-prep
In NSW you can now contact the PrEP Info Service, which provides further information for community members and health care professionals about Pre-Exposure Prophylaxis. Call the service on 1800 451 624, open Monday to Friday 9am till 5:30pm.
Heterosexual HIV info line 1800 812 404
Positive Life NSW
1800 245 677 (freecall)
This information has been produced by Pozhet in partnership with ACON