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“In 2021, around 38.4 million people were living with HIV, but around 5.9 million people were unaware of their exposure/risk of HIV” UNAIDS, 2022
With a substantial portion of the population being susceptible to HIV/AIDS, it is important to note that there are preventative measures available for different circumstances. Some of the most common prevention methods include medications like PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis). Both forms of medication are prophylaxis, which means ‘to prevent a disease/infection.’
So, what exactly are they, and how do they work?
PrEP – Pre-exposure Prophylaxis
1. What is it?
Pre-exposure prophylaxis (PrEP) is a medication that can be prescribed by practitioners before exposure to HIV (pre-exposure). PrEP works by preventing the replication of the virus and supporting the immune system in the fight against viral pathogens. They come in pill and injection forms. Currently, there are three approved medications of PrEP.
The three brands of HIV PrEP are:
Truvada (pills):
These are normally prescribed to people who are at risk of infection through intercourse or injections via needles.
Descovy (pills):
Usually given to people who are at risk of infection through intercourse
It is never given to women who are at risk of HIV through vaginal sex.
Apretude (injections):
Apretude is currently the only approved HIV PrEP that is administered through injections.
It is not recommended for people who are at risk of HIV through sex and weigh between 35kg to 77lbs.
Prescribed PrEP (pill) are recommended to be taken daily while injections are administered by a healthcare professional every two months. These medications commonly contain smaller doses of tenofovir and emtricitabine.
Common side effects associated with PrEP include aches, nausea, tiredness, diarrhea, and stomach pains. It is important to discuss these side effects with a healthcare professional to consider alternatives.
2. How effective is it?
Current statistics show that PrEP is effective (~99%) in preventing HIV that is spread through intercourse, while less effective (~74%) effective in preventing infections from sharing needles/drug administrations.
3. Myths surrounding PrEP
One common myth surrounding the use of PrEP is that you do not need condoms/other forms of prevention after starting PrEP. Although PrEP is effective in preventing HIV, it is still highly recommended to use other forms of prevention for STDs and infections aside from HIV.
PEP – Post-exposure Prophylaxis
1. What is it?
Post-exposure prophylaxis is a combination of three medications taken after possible HIV exposure (post-exposure).
The combined medication includes:
Tenofovir
Emtricitabine
Raltegravir or Dolutegravir
Raltegravir and Dolutegravir are prescribed based on the likelihood of the patient becoming pregnant. Those who are unlikely to become pregnant would be given Raltegravir, while those who are likely to become pregnant would be given Dolutegravir.
PEP targets the replication of HIV inside the body to prevent further spread of the virus.
2. How effective is it?
PEP is a combined treatment that is supposed to be taken for 28 days. If the treatment is started within three days, it is 80% effective.
3. Frequent questions regarding PEP
Can PEP be used as a replacement for PrEP and other forms of prevention?
PEP is not recommended as a replacement to other measures such as PrEP. PEP is meant to be taken as an emergency medication after exposure and should not be used as a normal prevention because it contains more/higher doses than PrEP.
What’s Next?
“Since 2015, there has been an increase in the number of people starting either PrEP or PEP” CDC, 2021
With the overwhelming number of HIV/AIDS cases that still exist it is important to be aware of the preventative measures available, the effectiveness of each medication, and how they work. Both post and pre-prophylaxis can effectively prevent the spread of HIV and reduce the number of deaths as a result.
Want to know more about treatments and prevention? Check out @MacCANFAR on Instagram to learn more!
References
Center for Disease Control & Prevention. (2016). Basic Questions and Answers About Post-Exposure Prophylaxis (PEP). https://www.thebody.com/article/basic-questions-and-answers-about-post-exposure-pr
Citroner, G. (2018). Cost of HIV Prevention Drug Discouraging People from Doing PrEP Therapy. Healthline. https://www.healthline.com/health-news/cost-of-hiv-prevention-drug-discouraging-people-from-doing-prep-therapy
Debunking Common Myths about PrEP. (n.d.). Retrieved March 10, 2023, from https://alto.com/blog/post/common-myths-about-prep
Geier, C. (2018). Replace dolutegravir (Tivicay) with raltegravir (Isentress) for post-exposure prophylaxis. ALiEM. https://www.aliem.com/raltegravir-post-exposure-prophylaxis/
Post-exposure prophylaxis (PEP). (2021, July 23). CATIE - Canada’s Source for HIV and Hepatitis C Information. https://www.catie.ca/post-exposure-prophylaxis-pep
Pre-Exposure Prophylaxis (PrEP) | HIV Risk and Prevention | HIV/AIDS | CDC. (2023, March 8). https://www.cdc.gov/hiv/risk/prep/index.html
PrEP | HIV Basics | HIV/AIDS | CDC. (2022, July 11). https://www.cdc.gov/hiv/basics/prep.html
PrEP for HIV Prevention in the U.S. | Fact Sheets | Newsroom | NCHHSTP | CDC. (2021, November 23). https://www.cdc.gov/nchhstp/newsroom/fact-sheets/hiv/PrEP-for-hiv-prevention-in-the-US-factsheet.html
Washington Health Institute. (2021). What is PrEP and How Does it Work? Washington Health Institute. https://dc-whi.org/what-is-prep-and-how-does-it-work/
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