PrEP – medications that prevent HIV

HIVRFSL

PrEP (pre-exposure prophylaxis for HIV) is drugs against HIV that an HIV negative person can take to avoid contracting HIV. PrEP is approved and can be administered by doctors in Sweden today. However, the high costs of the drugs and the follow up treatment means that the access to PrEP is still low.

Many drugs that can be used as PrEP are approved by the Swedish Medical Products Agency, for example Truvada and generic drugs. PrEP is covered by the high-cost protection, which means that the individual won’t have to pay more than 2 200 SEK per year for PrEP or any other prescription drugs. In a newly published knowledge report, the Swedish Public Health Agency concludes that PrEP should be administered to individuals when doctor and patient both feel that there’s a greatly increased risk for HIV infection. Guidelines for how PrEP should be prescribed have been produced by the Swedish Reference Group for Antiviral Therapy (RAV). Doctors in Sweden thus have the possibility to prescribe PrEP. However, the high costs of drugs and follow up treatment mean that many clinics can’t afford to prescribe PrEP. As it hasn’t yet been decided how clinics should be compensated for this, the accessibility of PrEP is still low.

Today, Truvada is widely used as PrEP in the States, and it’s also being used in a handful of European countries. Since the patent for Truvada expired earlier this year there are now significantly cheaper generic drugs available on the market. PrEP is usually taken continuously as one pill a day during the time you want the protection. It is this continuous use that has been approved for PrEP in Sweden. However, research shows that it can work when taking the medication 2-24 hours before having sex and during the two following days.

How effective is PrEP?

Research studies have shown that PrEP can prevent HIV from being transmitted during sex. Among men who have sex men, the two biggest European studies have shown that PrEP can decrease the risk of contracting HIV by 86% compared to people who don’t take PrEP. The medication thus gives a very good, but not complete, protection against HIV. It’s important to know that PrEP doesn’t protect against other sexually transmitted infections.

A person who has sufficient levels of PrEP in their blood, their rectum and genitals will have protection against HIV, as the drug prevents the virus from getting into the body’s cells and start multiplying. In order for PrEP to work the person must take their medication continuously, according to the prescription, to prevent the levels of the drug in the body from becoming too low leading the protection to disappear.

In those cases where PrEP hasn’t worked as a protection the reason is most often that the person hasn’t taken their medication as prescribed.

What can be negative about PrEP?

PrEP is HIV medications that have relatively few side effects. However, the body has to get used to the medication, and when first starting on treatment you may experience nausea, fatigue, stomach problems and headache.

There is a concern that HIV will become resistant to the components of the drug because of PrEP. If people who use PrEP unknowingly contract HIV (or are already living with HIV when the PrEP treatment is initiated) and continue using only Truvada or similar drugs, this can give the virus the opportunity to develop resistance against the drug, since an HIV infection requires many types of antiviral drugs to keep the infection in check. That’s why it’s important that only people who don’t have HIV get PrEP. HIV testing before PrEP is administered and also regularly during the time that PrEP is used is crucial.

Truvada is an expensive drug, which affects the doctors’ willingness to prescribe it. Since the patent on Truvada expired this summer, significantly cheaper generic drugs have emerged. Lowered costs will likely make it easier for doctors to prescribe PrEP and thus make PrEP more accessible.

If you use PrEP it’s important to have regular follow-ups of especially renal values, since PrEP can sometimes affect the kidneys negatively. This is often reversible when you stop taking the drug.

What does RFSL think about PrEP?

RFSL wants PrEP to be yet another way of working with HIV prevention in Sweden. Condoms are effective when they are used, but not everyone succeeds in using them. HIV will continue to spread, especially within more vulnerable groups. PrEP can’t replace other ways of working with HIV prevention, but would be a complement to the methods already in use.

RFSL thinks that PrEP should be offered to people who run an increased risk of contracting HIV. This should include, but not be limited to, MSM who engage in condomless sex with new partners, trans people who engage in condomless sex with men, and sex workers. We know from previous studies that the level of self-selection is high, i.e. that those who ask for PrEP also are in need of it. Thus, PrEP should be offered generously to people who ask for PrEP, when the individual and the doctor both feel that there’s an increased risk of HIV infection.

How do I get PrEP?

Address the issue of PrEP when you visit your county council’s HIV/STI clinic for testing and tell your doctor that you’re interested in using PrEP. Doctors have the ability to prescribe PrEP, so if they don’t want to do it, ask why and refer to the Public Health Agency’s knowledge base, the guidelines for prescription from RAV and FASS. You should be able to get access to PrEP if you are a person with an elevated risk of contracting HIV.