Pre-exposure Prophylaxis: Definition, How Is It Used, and Guidelines – In 2012, the WHO recommended the use of PrEP for transgender and serodiscordant couples. This recommendation is further strengthened, where in 2014, who drew up the combined guidelines for HIV and in which, the use of PrEP is highly recommended for LSL (WHO, 2015).
The U.S. Food and Drugs Administration (FDA) has also approved the use of TDF and FTC as PrEP, which followed the Public Health Service and CDC in 2014 issuing clinical guidelines for the use of PrEP in the U.S.
In 2015, WHO again issued guidance on the use of ARV and also discussed specifically about PrEP and UNAIDS also issued several references and advocacy that supported the conduct of PrEP as an additional method that is quite effective in HIV prevention based on the results of clinical research that has been conducted (UNAIDS, 2015).
Data shows that approximately two million new human immunodeficiency virus (HIV) infections occur each year worldwide. Since there is no effective vaccine available to prevent HIV transmission, prevention strategies are needed for this. One of the HIV acquisition prevention strategies is the provision of HIV Pre-Exposure Prophylaxis HIV (PrEP). For HIV-negative patients with high-risk behavior, PrEP using antiretroviral drugs is a proven way to prevent new HIV infections.
What is Pre-exposure Prophylaxis (PrEP)?
Prophylaxis means the prevention of infection with the drug. Exposure is an event that poses a risk of transmission. So pre-exposure prophylaxis (or PrEP) means the use of drugs to prevent infection before a risky event occurs.
Pre-exposure prophylaxis or PrEP is a new HIV prevention option for HIV-negative people to reduce the risk of being infected with HIV. PrEP for HIV prevention consists of the use of antiretroviral drugs (ARV) by HIV-negative people to reduce the risk. Large studies show that PrEP can help prevent new HIV infections when used by people at high risk of contracting HIV.
Research on PrEP was only done with the use of a combination of Truvada (a combination of tenofovir and emtricitabine). The study showed HIV transmission decreased by 90% after PrEP was used four times a week, and 99% when used once a day.
There is not yet enough information regarding the use of other drugs. It is not yet known whether other drugs or dosage schedules (e.g. Several times a week, replacing daily) may also be a good way to reduce the risk of HIV.
Truvada as PrEP was studied in people who are at high risk of HIV infection. The study involved men having s**ex with men (LSL), transvestites and high-risk heterose**xual people who were HIV-negative. The results of this study vary, research shows that PreP is most effective for people who actually take the drug every day.
Before deciding on the initiation of PrEP HIV, clinicians should conduct a number of evaluations. These evaluations include a substantial risk assessment of HIV acquisition, clinical eligibility evaluation for PrEP initiation, PrEP initiation regimen, monitoring, and discontinuation of PrEP.
How Is PrEP Used?
Currently PrEP consists of one Truvada tablet every day. Truvada can be used with food, or on an empty stomach. There is ongoing research that trials other drugs for PrEP.
Truvada contains two drugs, tenofovir and emtricitabine.
Who Should Use PrEP?
PrEP is more than just taking ARV pills. The FDA-U.S. has issued several guidelines for the use of PrEP, including one for LSL and another for heterose**xual people. The guidelines propose several requirements:
- PrEP should be used by people at high risk of HIV infection through se**xual activity
- PrEP should be part of an overall HIV prevention program, including con**doms and counselling
- Before using PrEP, the person must be tested for HIV to ensure that he or she is not infected with HIV
- Each PrEP user should be tested for HIV periodically to ensure he or she is not infected.
- Prospective PrEP users should also be screened for kidney damage, hepatitis B and any se**xually transmitted infections
- PrEP can also be used temporarily by discordant couples (one infected with HIV, the other not) who want to have children. However the use of PrEP of this is not yet approved.
HIV Drug List