PrEP

PrEP stands for Pre Exposure Prophylaxis. The medication is taken to prevent infection with HIV. The medication must be taken exactly as directed in order to be effective.

Can I buy PrEP online?

The Online Clinic is prepared to prescribe a medication called Truvada following an online consultation with a doctor. We will require some baseline testing to be done to ensure the medication is appropriate for you. All of the testing is organised through our clinic online. You do not have to attend a clinic for your tests. Please complete a free online consultation to get started.

What exactly is PrEP?

PrEP is a combination of two medications - Tenofovir disoproxil and Emtricitabine.

PrEP is taken to prevent an HIV infection. The medication must be taken in advance of a sexual encounter and we will describe the different dosing regimens that are recommended.

PrEP is only recommended for people who are HIV negative but at potential risk of contracting HIV. These include:

• People with a recent sexually transmitted infection (especially a rectal infection or Syphilis).
• People who have sex without condoms and are not in an exclusive relationship where the status of their partner is known.
• People who use certain recreational drugs when having sex – this is known as chem sex. Chem sex drugs include GHB, Crystal Meth and Mephedrone.

People in a relationship with someone who is HIV positive but who is on treatment with an undetectable viral load are not usually recommended to take PrEP. This is because the HIV treatment dramatically reduces the risk of transmission. You should discuss this with your partner's HIV doctor if this situation applies to you.

Is PrEP effective?

PrEP is highly effective if taken exactly as prescribed by your doctor. A UK study called PROUD following two groups of patients (one group on PrEP and the other group deferred for a year) found that there was an 86% reduction in risk of HIV infection if someone is using PrEP. The study looked at 500 men who have sex with men (MSM) and also trans women. The medication was so effective that the trial had to be ended early for ethical reasons and the patients in the control group placed on PrEP.

Another study of MSM in France and Canada, known as the IPERGAY study, also produced an 86% reduction in infection rates.

The Partners study in Africa looked at heterosexual sexual relations and this reported an infection rate reduction of 96% if the participants adhered to the dosing regimen prescribed.

How do I take PrEP?

PrEP can be taken in different dosing regimens. It can be taken as a daily dose or an events-based dose.

Daily PrEP

This involves taking the medication daily.

For vaginal sex (as the receptive partner), you will need to have taken the medication for at least 7 days prior to the sexual encounter and continue for at least 14 days thereafter for the appropriate level of protection to be achieved.

With anal sex, you can take a double dose 24 hours before the sexual event and continue at a one a day dose thereafter. After one week at the one a day dose, you can take the medication on 4 days of the week and retain adequate protection for anal sex. Please note that this regimen is NOT appropriate for vaginal sex. The 4 days a week regimen is called “the Ts and Ss” as it is taken on Tuesday, Thursday, Saturday and Sunday.

Events-based Dosing (EBD)

This dosing regimen is for anal sex only. You take a double dose around 24 hours prior to the encounter and one pill 24 hours after the event and one 48 hours after the event. If you have multiple sexual encounters then you must ensure that you continue on the one dose a day until you have 2 sex-free days.

EBD is not suitable for someone who has an active Hepatitis B infection. Only the daily dosing regimen must be used in these cases. Please note that The Online Clinic will not prescribe PrEP for any patient with an active Hepatitis B infection.

Holiday PrEP

If you are planning a holiday where you may experience a higher level of sexual activity then you can take a daily dose for 7 days prior to the holiday, a daily dose for the duration of the holiday (at least 7 days) and then every day for 7 days after you return home. This regimen is appropriate for anal and vaginal sex.

If you want to change your dosing regimen, we can provide specific advice around that.

PrEP Side Effects

As with all medications, PrEP can cause side effects but most people do not get any side effects at all. Side effects experienced by some patients include:

• Nausea
• Headache
• Bloating
• Diarrhoea

PrEP can rarely cause a reduction in kidney function and a reduction in bone density. The Online Clinic will monitor your renal function while on treatment and we will not prescribe for patients who have other risk factors for osteoporosis (reduction in bone density).

Testing

The Online Clinic will arrange tests prior to initiating you on PrEP. These tests will be used to establish that PrEP is safe for you. We will test your renal function, your HIV status and whether you have Hepatitis B.

Every 3 months we will check you for HIV and other STIs. We will also check your urine for protein, to ensure that your kidneys are continuing to function properly.

Every 12 months we will check your renal function using a blood sample.

You can find out more about the latest news on PrEP on the NAT website.