PrEP – Pre-exposure Prophylaxis

PrEP means Pre-Exposure Prophylaxis. Prophylaxis means prevention. PrEP is used by HIV negative people to prevent them being infected with HIV. This is a pill containing two anti-HIV drugs, tenofovir and emtricitabine, either taken regularly or before and after sex.

Who's suitable for PrEP?

HIV-negative men who have sex with men (MSM) / trans⃰ who have had condomless anal sex in the last three months and are likely to continue to do so.

HIV negative people who are having sex with a partner who is HIV positive and whose virus is not undetectable (suppressed by treatment).

Other people with risks may be individually suitable but this needs to be decided by a doctor specialised in the use of these medicines and who is able to determine the risks of the activities undertaken by that person.

Where and how to get PrEP?

The HIV drugs used for PrEP cannot be currently prescribed on the NHS to prevent HIV through PrEP unless in the context of a trial which most sexual health clinics have some spaces for patients to be entered into.

The fact it isn’t more widely available is frustrating for healthcare professionals as well as for you.

It is legal to buy generic (non-branded) PrEP for personal use (3 months’ worth of the drugs) from outside the EU. You need to make sure that the pill you order contains both tenofovir and emtricitabine. If you want to buy PrEP you can access a supply from here.

A month’s supply is getting cheaper as more companies are making the medication. As per April 2018, it costs about £19/month to buy. The manufacturers listed on this website have been checked and the pills supplied are genuine. The NHS uses generic medications more and more as the branded drugs come off patent. This website has a lot of information on it. Not all may be relevant to you but it is very useful to read.

If you don't understand it, it is best that you come into one of the sexual health clinics to talk to a doctor or health advisor, as PrEP is complex.

The Departments of Sexual Health will look after you (by monitoring your blood and urine tests) whilst you are taking the tablet.

Important Information APRIL 2018 - The PrEP trial is available at the local sexual health clinics and at Over the Rainbow – but spaces are limited and only eligible patients can enter, these criteria are national and are not determined by the staff at the clinic. For more information visit the PrEP Impact Trial website or speak to your clinician.

Before you start

Ideally, speak to one of the senior doctors at the clinic before starting PrEP, but don’t be worried if you have already started before you attend.

It is important for you to be tested for HIV before starting PrEP. This is because the medicines used for PrEP are also used for treatment for HIV, and if you are already infected but don’t know that you are, your future treatment options may be limited or you could become resistant to the medication if you miss or take a late dose.

You should also be tested for hepatitis B before starting PrEP. This is because the medicines are also used for a treatment of this infection, and it may affect how we advise you to take PrEP. If you are infected with hepatitis B, you might also need to see a liver specialist. If you don’t have hepatitis B and haven’t been vaccinated, we would strongly advise that you get vaccinated.

You need to have an STI screen, a urine test and a blood test to check your kidney function; the drugs can sometimes affect your kidneys so we need to know how well they are working before you start.

The doctor / health adviser you see will also talk to you about the best way to take the PrEP tablet.

Whilst you are on PrEP

Whilst you are taking PrEP you should have regular HIV, STI and urine tests – every three months. Once a year at least, you should have a blood test to check your kidney function.

If you get ill with fevers and /or if you have missed some pills and had sex, you will need to come in sooner and have an HIV test in case you have “seroconverted” (ie become infected with HIV). It is important to identify this early so we can get you on the right medication and test any contacts you could have caught the infection from.

Stopping PrEP

It is important to speak to a doctor before you stop PrEP. 

Stopping PrEP should be timed correctly after the last risk, and you (and your partner if relevant) should have an HIV test at least 4 weeks after your last risk. That said, if you are no longer having the same risks, it’s not sensible to stay on PrEP just because it is “easy” to do so.  There are some long-term risks associated with these drugs, as there can be with any medications. As outlined about, they can affect the kidneys and also the bone health.

Sources of information

This is an amazingly handy guide to taking PrEP and has all the information that you need.

It is also available online.