PrEP – drugs that prevent HIV transmission

HIVRFSL

PrEP (Pre-exposure prophylaxis for HIV) is antiviral medication for HIV that an HIV-negative person can take to avoid contracting HIV. PrEP is approved by the Swedish Medical products Agency, but is still not available for use.

Truvada is the drug most often used as PrEP and is approved to use as PrEP treatment for HIV-negative individuals. However, there is no protocol describing how PrEP should be prescribed and to whom, and how follow-up visits should be conducted. Thus, it is not yet available to the user even though it has gotten the needed approval.

Today, Truvada is readily used as PrEP in the USA and in a few European countries, such as Norway and France. PrEP is often taken as one pill a day during the time you want to be protected. Research shows that it can also be effective if taken 2-24 hours before sex, and during the two following days.

How Effective is PrEP?

Studies have shown that PrEP can prevent HIV from being transmitted sexually. Two big European studies have shown an 86 % decrease in the risk of contracting HIV for PrEP users, compared to those who do not use PrEP, so the medication does not provide 100% protection from contracting HIV. PrEP does not provide protection from contracting other sexually transmitted infections.

Someone with adequate levels of PrEP in their blood, anus, and genitals will have a protection against HIV, since the drug prevents the virus from accessing the cells of the body and multiplying. The medication must be taken as prescribed to have the desired effect.

If one does not take the medicine as prescribed, PrEP can be ineffective. This has been the case for most people who have seroconverted on PrEP.

Are There Negative Effects of Using PrEP?

Truvada has relatively few side effects, however, the body does need to adjust to the medication, with nausea, fatigue, stomach problems and headaches being common when starting treatment.

There are concerns that HIV will become Truvuda resistant because of PrEP, where someone is unaware of being HIV positive and continues to take the drug, giving the virus the opportunity to become resistant. In the treatment of HIV, several drugs are combined, so it is essential that only those who are HIV negative take PrEP, and that HIV tests are administered continuously.

Doctors’ willingness to prescribe PrEP is affected by the fact that Truvada is a very expensive drug.

If you are a PrEP user it is important with regular follow up visits to your doctor, to control for example kidney function. In some cases PrEP can affect your kidneys negativley. Often this effect is reversed when stopping PrEP. Unfortunately it can be hard to find a doctor who is willing to do these follow up tests, as Sweden does not to this day have national guidelines on how to do them or who are responsible for the costs.

What Is RFSL’s opinion on PrEP?

RFSL wants PrEP to become a useful tool for the HIV prevention in Sweden. Condoms are effective when used, but not everyone uses them, and HIV continues to spread, especially in vulnerable groups. PrEP cannot replace other methods of HIV prevention, but it is a good complement to existing tools.

RFSL believes that the use of PrEP should be subsidised for MSM who have multiple unprotected sexual encounters, sex workers, and couples where one part is HIV positive, and does not have effective treatment, and the other is HIV negative.