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PrEP

Pre-Exposure Prophylaxis (PrEP) is the use of antiretroviral medication to reduce the risk of getting HIV.

PrEP is taken regularly in case you are exposed to HIV. When there’s enough of the drug in your system, it can prevent HIV from surviving.

When PrEP is taken every day as prescribed, it can reduce your risk of getting HIV by almost 100%.

PrEP has been used as a form of HIV prevention for over a decade and is a fantastic option for many people who are at increased risk of getting HIV.

Who can take PrEP?

PrEP is a great option for anyone who is HIV-negative and at a medium or high risk of getting HIV. It can also be a great option for people who are at lower risk but have high levels of anxiety about getting HIV.

If you don’t always use condoms, then PrEP might be right for you.

Other factors related to a higher risk of HIV include:

  • A recent STI (especially rectal infection or syphilis)
  • Recent need for PEP
  • Using recreational drugs for chemsex (crystal meth, mephedrone, GHB)
  • If your partner is HIV-positive and finds it hard to stay on their meds

Talk to your doctor about PrEP and how these risks affect you.

How do I get PrEP?

If you want to take PrEP you will need to get a script from your doctor.

Any doctor or nurse practitioner can give you a prescription, but you might prefer to talk to someone who has experience in providing PrEP. The WA Department of Health maintains a list of trained PrEP prescribers.

M Clinic also hosts a PrEP prescribing clinic called LinQ Medical.

You will need to get tested for a few things:

  • HIV blood test
  • Kidney function test
  • Full sexual health screening – including syphilis and hepatitis B

It’s important that you have an HIV test before you start taking PrEP because it only works if you don’t have HIV. If you already have HIV and don’t know it, you could develop drug resistance.

In rare cases, PrEP can reduce kidney function, so we need a baseline. Kidney tests are usually just a blood sample and occasionally a urine sample. These tests are best done just before or on the day you start PrEP.

If you have hepatitis B (HBV) you can still take PrEP, but it needs to be used more carefully. You will need to take PrEP every day and need to talk to your doctor if you want to stop PrEP.

Be careful about starting PrEP if you have flu-like symptoms and had a recent HIV risk. This is in case these symptoms are related to a recent HIV infection.

How do I take PrEP?

There are a few different ways to take PrEP. Most PrEP studies looked at PrEP taken daily – this is the recommended way of taking it. On-demand PrEP is another option, though less effective.

Daily PrEP
If you have sex regularly or want consistent HIV protection, taking PrEP daily is the best option.

Daily PrEP involves taking one pill a day, every day. It keeps sufficient levels of the drug in your body 24/7. You can have sex when you want and involves less need for planning.
You need to take daily PrEP for 7 days to achieve full protection. If you are a cisgender man, however, you only need a single dose of two pills to reach a high level of protection and continue with daily PrEP.

If you miss a dose, daily PrEP still provides a high level of protection, though you want to avoid missing doses as much as possible. It’s a good idea to find a routine that works for you so you can take your pills at the same time every day. Consider using things like calendars or tracking apps on your phone to make sure you remember to take your pill.

On-Demand PrEP
For some people, taking PrEP daily might feel like the best option, so on-demand PrEP, also called event-based or 2-1-1 PrEP, is another option. It involves taking a specific sequence of PrEP around the times you are having sex and requires planning in advance. It is less effective than daily PrEP (94% vs 99%). On-demand PrEP can only be used for cisgender men having anal sex.

Taking on-demand PrEP

Here are the steps to on-demand PrEP:

  1. Take two pills between 2 – 24 hours before you have sex
  2. Take one pill 24 hours after the double dose
  3. Take one pill 48 hours after the double dose
  4. If you have repeated sexual activity, take one pill every day until 48 hours have passed since you last had sex.

It’s vital you follow the steps correctly. Taking PrEP too far apart or not taking enough means you won’t be properly protected.

Talk to your doctor about whether this is the right option for you.

Do I need to keep using condoms?

While PrEP does a fantastic job at preventing HIV, it does nothing to stop STIs like chlamydia, gonorrhoea, syphilis and herpes.

WA is currently experiencing a syphilis outbreak so it’s important to protect yourself.

Not everyone loves using condoms, but they are the best way to prevent HIV, STIs and pregnancy. And you can get them for free from all our services and all over the place.

If you don’t know your size, you can also order a FREE sample pack of different sized condoms.

Studies show that anxiety around sex is significantly reduced for people who use both condoms and PrEP, which can have sex be a whole lot more fun and pleasurable!

I’ve started PrEP! What next? What do I have to keep doing?

Once you start PrEP, monitoring is just as important.

You need to have a check-up one month after commencing PrEP to make sure your kidneys are coping with the medication, also to have a repeat HIV test.

Following this, you should have a check-up every three months, no matter what type of dosing regimen you use. If you are currently using PrEP and have not been monitored, talk to your doctors about doing this now.

Every 3 months:

  • Have a ‘4th generation’ HIV blood test
  • Have a full screen for other STIs, including syphilis and hepatitis B and C
  • Have a blood and urine test to check your kidney function.

Remember, PrEP only works to prevent HIV so if you are sexually active and want to prevent STIs like syphilis, chlamydia and gonorrhoea, using condoms is the best way.

Frequently Asked Questions

Does PrEP work with any other STIs?

PrEP does not protect against other STIs. Condoms can help prevent many other STIs. Although STIs are mostly easy to treat, symptoms can sometimes be unpleasant and sometimes serious.

This is why regular testing for STIs is a good idea.

Make sure you are protected from as many infections as possible. Hepatitis A + B vaccinations are available and are usually recommended if you are taking PrEP. The HPV vaccine can protect against genital warts and cervical/anal cancers. It is available for some gay men but there may be a charge.

Are there side effects? I’ve heard there are side effects!

The majority of people taking PrEP do not get side effects.

However, like all medicines, PrEP has the potential to cause side effects. In studies, mild nausea, diarrhoea, bloating and headache were reported in the first month by less than 1 in 10 people. These side effects then usually stop within the first month or so.

Occasionally, PrEP can cause more serious side effects that reduce kidney function and/or bone health. For this reason, regular check-ups and monitoring kidney function is part of your doctor’s procedure to get a script for PrEP.

Are there side effects? I’ve heard there are side effects!

The majority of people taking PrEP do not get side effects.

However, like all medicines, PrEP has the potential to cause side effects. In studies, mild nausea, diarrhoea, bloating and headache were reported in the first month by less than 1 in 10 people. These side effects then usually stop within the first month or so.

Occasionally, PrEP can cause more serious side effects that reduce kidney function and/or bone health. For this reason, regular check-ups and monitoring kidney function is part of your doctor’s procedure to get a script for PrEP.

Is there anyone who should not take PrEP?

PrEP should NOT be used by people who are HIV positive.
PrEP is usually not needed if:

  • The negative person only has HIV positive partners who are on ART with undetectable viral load. An undetectable viral load means that an HIV positive person is not infectious.
  • If you are happy and able to always use condoms.
Who can prescribe PrEP?

PrEP can be prescribed by any doctor or nurse practitioner.

Certain GPs have undertaken training on prescribing PrEP to the community. Check out the list.

We also have a Medicare-billing PrEP Clinic within the M Clinic. It’s called LinQ Medical.

The clinic is staffed by doctors and nurses that provide education and appropriate testing to ensure that you are taking PrEP safely and correctly.

How much does PrEP cost?

Once you have a PrEP prescription, you can go to the pharmacy and get your PrEP just like any other medication. PrEP is listed on the Pharmaceutical Benefits Scheme (PBS), which keeps the cost low for people with a Medicare card. It gets cheaper for people with concessions.

If you are Medicare ineligible and unable to get PBS listed medication, it can be expensive to buy at a pharmacy. Many people choose to personally import their PrEP from overseas as a safe and affordable option. See the table for more information.

Description Cost Link
Australian Pharmacy (PBS) Requires a prescription. Purchase PrEP at a local pharmacy (requires Medicare) $39.50/month ($6.40/month with concession) PrEP on the PBS
Personal Importation (for people without Medicare). Requires a prescription. Import generic medication from overseas pharmacies via Personal Importation Scheme. See links for more information. PrEP access now (PAN)
PrEP Global
What do I do if I miss a pill?

Missing one dose is unlikely to cause any problems. If you miss one, this will be fine. Don’t stop PrEP, just carry on once you remember. Drug levels will still be high enough to protect against HIV.
If you are missing several doses each week, please talk to your clinician about support.

If you use daily dosing and miss more than a week of pills, then restart with a double dose (two pills) and then continue with one pill a day. Never take more than one double dose when you start PrEP. You only need one double dose at the start. More than one double dose in a week may be harmful. Do not take more than a total of seven pills in one week.

  • Pick a regular time and try to stick to this each day. Link it to a routine task like brushing your teeth. It doesn’t have to be the exact same time but it will help get you into a routine.
  • If you have a break from PrEP and have risks during this time, it is important to have another HIV test.
How do I stop taking PrEP?

Stopping PrEP is OK as long as it is done safely.

If you want to stop taking PrEP altogether, it is recommended you continue to take it for 28 days after your last potential risk. That is because if you have been exposed to HIV during that risk event the medication continues to protect you until the virus is dealt with.

If you’re a cisgender man who has sex with men, the current recommendations say you only need to take PrEP for two days after your last risk event and then you can stop.

It’s wise to discuss your decision to stop with your doctor. You might want to discuss plans to stop PrEP with your partner(s) and get tested for HIV and other infections together.

If in the future your circumstances change again, it is easy to restart PrEP. If you stop PrEP and have a risk afterwards, contact your clinic in case post-exposure prophylaxis (PEP) might be needed. In the cases when PEP is used, it needs to be started as soon as possible.

How does PrEP work?

PrEP works by blocking HIV’s ability to replicate. HIV needs to enter CD4 cells (a type of immune cell) for it to be able to reproduce and spread.

PrEP creates a wall around CD4 cells, blocking off the receptors into the cell. This means that HIV can enter the body but won’t be able to replicate itself and won’t be able to spread throughout the body.

Essentially, PrEP is the bouncer at a club, keeping out people who are intoxicated and aggressive and maintaining a safe and enjoyable space to party.

How long does it take for PrEP to work?

There needs to be sufficient levels of the drug in your body for it to protect you from HIV. For most people, it takes 7 days of daily dosage for it to reach the optimal levels you need for protection.

If you are a cisgender man, taking two pills at the beginning will get you to high levels of protection in less than a day. This is not the case for anyone else.

How well does PrEP work?

PrEP is highly effective at reducing the risk of HIV infection. PrEP works extremely well if taken correctly.

PrEP is over 99% effective at protecting you from HIV infection if taken every day without missing any doses. Some people may choose to take PrEP in an “on-demand” or an event-driven way; however, the efficiency can drop to around 86%.

I’m trans. Can I still take PrEP?

Absolutely!

PrEP is beneficial for anyone who wants to reduce their risk of HIV, including trans and gender diverse people. PrEP has not been shown to affect your levels of transition-related hormones (testosterone, estrogen, etc.) but it is recommended that you take PrEP daily as opposed to occasional use.

Talk with your doctor about PrEP and hormones for further support.

I’m HIV positive. Can I take PrEP?

Nope. PrEP is only useful at preventing HIV infection for HIV-negative people.
While the drugs in PrEP are used to treat HIV for some people, they are in higher concentrations, and PrEP will not effectively treat your HIV. In fact, taking PrEP if you are HIV-positive can result in drug resistance.

Your doctor will be able to prescribe medication that works best for treating you.
Taking your antiretroviral medication as prescribed and lower your viral load to undetectable levels. This means you cannot transmit HIV to others through sex. This is called Undetectable = Untransmittable or U=U.

I have hep B. Can I still take PrEP?

If you have hepatitis B, it is important that you take your PrEP every day. The drugs in PrEP are also used as part of the treatment for hepatitis B. This means missing doses can have implications for your treatment and potentially impact your liver.

Make sure you talk with your doctor about your hepatitis B treatment and taking PrEP so they can manage your care in the best way possible.

How long has PrEP been around?

The drug combo in PrEP (emtricitabine and tenofovir) have been used in Australia to treat HIV since 2004. It has been used to prevent HIV in people that are negative as post-exposure prophylaxis (PEP) since 2005.

In 2012, Truvada was approved to be used as PrEP in the USA, It was approved for use in Europe in 2016 approved in Australia by the TGA in April 2017. PrEP became available on the PBS (Pharmaceutical Benefits Scheme) in Australia in April 2018.

What is in PrEP?

PrEP is a two-drug antiretroviral medication containing emtricitabine and tenofovir disoproxil fumarate.

Truvada is the main brand name but it is also available in generic, non-branded versions.

Does PrEP interact with other medicines?

PrEP does not interact with most other medicines. But if you are prescribed other meds, always tell your doctor (including your GP) that you are taking PrEP. You can also ask a pharmacist to check for drug interactions, including with over-the-counter meds.

One important exception is that tenofovir (TDF) does interact with some non-steroidal anti-inflammatory drugs (NSAIDs), especially diclofenac. Taking both drugs together can cause kidney problems. Other NSAIDs include ibuprofen and naproxen. Avoid using these meds if you are taking PrEP, or let your doctor know if you need to take them.

Info on interactions between PrEP and other meds, including hormone treatment is on this site from Liverpool University. There is also a free app that is downloadable on most phones – search for ‘Liverpool HIV iChart’.

Can taking PrEP lead to HIV resistance?

If you take PrEP correctly, the chance of drug resistance is very low.
Firstly, resistance relates to HIV and not the person. So an HIV negative person can’t be resistant. Secondly, resistance is only a risk if you become HIV positive. Even then the risk is low.

The risks of drug resistance are from:

  • Starting PrEP without knowing that you are already HIV positive. This is why the HIV test before PrEP is essential.
  • Becoming HIV positive during a break from PrEP and then not having an HIV test before restarting.
  • Missing too many PrEP doses, so that drug levels are too low to prevent HIV infection.
  • Contact with drug-resistant HIV. This is very rare: globally, only two cases have been reported of PrEP not working because of drug-resistant HIV
How do I know if someone is taking PrEP?

There is no way to know if someone you are having sex with is really on PrEP (or taking it correctly).

Only you can be sure if you are using PrEP to prevent HIV. If you are worried about the risk, you can use condoms and lube for additional protection.

More information

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