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HIV PrEP & HIV PEP For HIV Prevention

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Transcript from video:

Hi, I’m Dr. Jonathan Ti from Dr. Tan and Partners, and today I’d like to talk about HIV PrEP.

PrEP stands for Pre-Exposure Prophylaxis, and it has emerged in recent years as one of the most effective ways to prevent HIV infection. Individuals taking PrEP can reduce their risk of getting HIV by upwards of 95%. This type of medication must be taken before any risk exposure to be effective. It is different to Post-Exposure Prophylaxis, or PEP, which is taken immediately after a possible exposure and uses additional medications.

PrEP is usually taken as a once daily tablet, a combination of antiviral drugs tenofovir and emtricitabine. Other types of dosing regimens are available as well, depending on the unique lifestyle of the individual. Studies have shown that PrEP is generally safe for long term use, but some may experience side effects such as a reduction in kidney function and bone density, especially with the older version of medication called Truvada. The US FDA recently approved a newer drug called Descovy for use as PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for kidney and bone toxicity. The main difference between Descovy and Truvada is the form of tenofovir drug present – the newer Descovy uses TAF, which enters target cells more efficiently than Truvada’s TDF, and means that a much lower dose of tenofovir is needed. This means that other tissues such as kidney and bone are exposed to a much lower dose of the drug and there is less risk of drug toxicity and side effects.

HIV PrEP is recommended for individuals who belong to a high-risk group for HIV infection, and who do not have any current established HIV infection. HIV high-risk groups may include:

  • Someone who has an HIV-positive partner
  • Someone who has multiple sex partners, a partner with multiple partners, or a partner whose HIV status is unknown and does not practice safe sex; there is higher risk in men who have sex with men or transgender women
  • Someone who has sex with commercial sex workers
  • Someone who has recently had a sexually transmitted disease
  • Someone who injects drugs, or has unprotected sex with someone who injects drugs

Both Truvada and Descovy are available in our clinics. They are only available by prescription. Please speak to our Doctors if you think PrEP is right for you.

Descovy As New HIV Medication For HIV PrEP

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What is HIV Pre-Exposure Prophylaxis (PrEP)?

HIV Pre-Exposure Prophylaxis (PrEP) is the use of medications to effectively prevent the transmission of HIV. Individuals who are taking PrEP can reduce their risk of contracting HIV infection by up to 99% if taken regularly. This type of medication must be taken before exposure to be effective. It is different from Post-Exposure Prophylaxis (PEP), which is taken immediately after possible exposure and uses additional medications.

PrEP is usually taken as a once-daily combination tablet of tenofovir disoproxil fumarate (TDF) + emtricitabine (brand name: Truvada), although other types of dosing regimens are available as well depending on the unique lifestyle of the individual. Studies have shown that PrEP is generally safe for long term use, but some may experience side effects such as a reduction in kidney function and bone density.

FDA Approved

The FDA recently approved a new drug combination of tenofovir alafenamide (TAF) + emtricitabine (brand name: Descovy) for use as PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for renal and bone toxicity.

The main difference between Descovy and Truvada is the form of tenofovir drug present – the newer Descovy uses TAF, which enters cells more efficiently than Truvada’s TDF, and means that a much lower dose of tenofovir is needed. This means that other tissues such as the kidney and bone are exposed to a much lower dose of the drug and there is less risk of drug toxicity.

The DISCOVER trial for Descovy as PrEP showed that the new drug is as effective as Truvada in preventing HIV transmission in men or transgender women who have sex with men, when taken as a once-daily tablet. They have not yet performed specific studies to evaluate protection in vaginal sex, or with other PrEP dosing schedules (such as Event-Based Dosing, T’s and S’s, etc.).

However, given that Descovy is essentially just a new and improved Truvada (which has been extensively studied in these situations), it is likely just a matter of time before further studies are done and show similar efficacy.

Descovy also includes a warning in usage as PrEP for patients with known hepatitis B infection, stating a potential risk of hepatitis B exacerbation after stopping the drug. While it can still be used as PrEP in patients with a history of hepatitis B infection, close monitoring of liver function and hepatitis B viral load for up to 6 months following discontinuation of Descovy is recommended (same as Truvada).

Speak To Our Doctors Today!

Descovy is currently available in all Dr Tan & Partners (DTAP clinics) in Singapore. It is a prescription-only medication and must be prescribed by a doctor. Speak to our doctors for more information about Descovy and find out if a HIV-1 treatment that contains Descovy is right for you. Dr Jonathan Ti, MB, BCh, BAO (Ireland), MRCP (UK), Cert. Men’s Health, is a member of the Singapore HIV PrEP Taskforce and is a co-author of the Singapore HIV PrEP Guidelines and is currently practising at our Robertson Walk Clinic.

HIV PrEP does not protect the user against other STDs. Therefore, even if you are on HIV PrEP, it is important to still to use a condom regularly, as well as get your regular STD screening & HIV Testing.

If you are interested to find out more about HIV PrEP, please call our any of our clinics or drop us an email at hello@dtapclinic.com.sg for an appointment with our doctors.

7 FAQs HIV Pre-Exposure prophylaxis (HIV PrEP)

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HIV Pre-exposure prophylaxis (PrEP) is a combination of 2 HIV medicines, sold under the name of Truvada (Tenofovir and Emtricitabine), when taken daily lowers the chances of a very high-risk HIV negative individual from getting infected with HIV.
Do not mistake this for Post-exposure prophylaxis (PEP) which is taken for 28 days after potential exposure to the HIV virus.
The precept is simple, take one pill a day and you are protected from getting HIV.
Also Read: A Guide To HIV PrEP And HIV PEP – Pills For HIV Prevention

7 Frequently Asked Questions on HIV Pre Exposure Prophylaxis (PrEP):

1) How effective is HIV Pre-exposure prophylaxis (PrEP)?

When used daily, it can lower the risk of getting HIV from sexual intercourse by 99%.
The protection against getting HIV from sharing needles is lower at about 70%.
Being on PrEP is NOT AN EXCUSE for going bareback. Using a condom further reduces the risk of getting HIV. Also, PrEP does NOT protect against other STDs. But condoms DO!
Also, remember that medicines work only if they are taken properly.
Also Read: STD Symptoms – That You Need to Know 

2) How to Take HIV Pre exposure prophylaxis (PrEP)

a. Event-Based HIV Dosing

On-Demand PrEP Regimen: 
Planned condom-less sex 24 hours in advance:
Strictly:

  • take 2 pills 2 – 24 hours before sex
  • take 1 pill on the day of sex
  • take 1 pill 24 hours later

If having sex for an extended period of time, perhaps over a few days or a weekend, continue to take a pill every 24 hours until you have 2 sex-free days.

Type: 

  • Only for Anal sex
  • More studies required to show effectiveness in Vaginal/Frontal sex

Considerations:

  • This option is not recommended if you have an active hepatitis B infection. The drugs in PrEP also suppress the hepatitis B virus and so starting and stopping HIV PrEP can potentially cause viral flare-ups and liver inflammation.

b. Daily PrEP

Daily PrEP Regimen: 

  • Lead-in time 7 days.
  • Taken daily at the same time  +/- a few hours ok

Type:

  • Anal, Vaginal/Frontal sex

Considerations:

  • Can be taken any time of the day with or without food
  • In the event a pill is missed, adequate protection is still conferred.

c. Ts and Ss (Tues, Thurs, Sat, Sun dosing)

Ts and Ss Regimen:

  • Daily dosing for 7 days,
  • then dropping down to 4 pills per week on Tues/Thurs/Sat/Sun

Type: 

  • Only for Anal sex
  • More studies required to show effectiveness in Vaginal/Frontal sex

Considerations:

  • If you only have sex once or twice a month, you might not want to take a pill every day.
  • 4 pills per week will maintain a good baseline of the drug in your system and you can choose to increase up to daily 7 pills per week when you know you’re in a more sexually active period.
  • Some people using PrEP On Demand find that they might be taking 4 pills per week most weeks of the month and so opt for structuring this into the Ts and Ss instead.

d. Holiday PrEP

Holiday PrEP Regimen:

  • PrEP before a pre-planned block of time when your risk of exposure to HIV will be higher due to:
    • an increased number of partners of unknown HIV status
    • situations where condoms are not easily or always used
    • where alcohol or substances might be used
    • having sex while travelling to a country with a high HIV prevalence
  • Based on a 7-day period we recommend 7-7-7:
    • 7 days daily dosing before the period
    • 7 days daily dosing during the period (or for as long as the specific period lasts)
    • 7 days daily dosing after the period.

Type: 

  • Anal, Vaginal/Frontal sex

Considerations:

  • 7 days of PrEP before and after your last sexual encounter for several reasons:
    • 7 days lead-in provides adequate levels for both anal and vaginal or frontal sex.
    • 7 days lead in before the holiday or travel will allow the body to adjust to any possible side effects; most people do not experience any, but should you have side effects, these will usually have subsided within a week.

3. Who should consider HIV Pre exposure prophylaxis (PrEP)?

  • If your partner is living with HIV
  • If you are not is a mutually monogamous relationship
  • If you have been diagnosed with an STD in the past 6 months

4. How long after initiation of HIV PrEP will it then provide protection?

The general rule is that you have to be on PrEP for 7 days before you are protected.
There are ways to speed this up and there are circumstances when this is longer. Please check with our doctor when you consult for your PrEP prescription.
Also Read: When To Test For HIV During Or After Completing HIV PEP

5. What are the side effects of HIV PrEP? Is it safe to take it long term?

PrEP is relatively safe. When side effects do occur, most common symptoms are nausea and diarrhoea. Generally, these symptoms usually subside over time. No serious side effects have been recorded and the side effects are never life-threatening.
However, if you do develop side effects that are not improving with time, please contact the doctor that prescribed you the PrEP.

6. How can I purchase PrEP?

You will need to consult a doctor first and he may go through with you your risks based on the type of sexual behaviour. The doctor will also run some blood tests, including HIV, Hepatitis screen, and other blood tests such as full blood count, kidney function test and liver function test. If there are no contraindications, the doctor will then prescribe you PrEP.
Learn more about Anonymous HIV Testing

7. Since PrEP is effective in providing protection, can I not use a condom for oral and anal sex?

Always use a condom. PrEP doesn’t give you 100 per cent protection. Using a condom while on PrEP significantly lowers your risk further. Besides that, HIV PrEP doesn’t protect you against other sexually transmitted diseases (STDs) such as gonorrhoea and chlamydia which can infect the throat, anus and penile urethra.
While on PrEP it is recommended to screen for HIV and other STDs regularly. We provide Rapid HPV Testing & Rapid Gonorrhoea & Chlamydia PCR Testing (Next Day Results).
Learn more about Descovy (New HIV Medication For HIV PrEP)

Descovy (brand name) is a FDA approved new drug combination of tenofovir alafenamide (TAF) + emtricitabine for use as HIV PrEP, which has shown to be equally effective in preventing HIV infection whilst touting an improved safety profile for renal and bone toxicity.

Descovy is currently available in all Dr Tan & Partners (DTAP clinics) in Singapore. It is a prescription only medication and must be prescribed by a doctor. Speak to our doctors for more information about Descovy and find out if a HIV-1 treatment that contains Descovy is right for you.

Take Care!

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Other Reads:

  1. HPV Infection & HPV Vaccination for Men who have sex with Men
  2. A Guide To HIV PrEP and HIV PEP – Pills for HIV Prevention
  3. Do I Have HIV Rash? Or Are They Other STD-Related Rashes?
  4. What are the Causes of Abnormal Penile Discharge?
  5. STD Risk for Receptive Unprotected Anal Sex in Men
  6. Low HIV Risk Doesn’t Mean No HIV Risk
  7. HIV PrEP for Travel – How You Need to Know
  8. An Overview on STD from an STD Doctor
  9. Everything You Need to Know about Herpes Simplex Virus
  10. How Do I Treat Oral Herpes (Cold Sores)
  11. Syphilis Symptoms – Painless Sore & Ulcers
  12. HIV Symptoms – What You Need to Know
  13. 10 Common HIV related Opportunistic Infections