HIV Prevention Options – PrEP/PEP By Chris Wade, HIV Care Connect Project Coordinator

Illinois Public Health Association, HIV Care Connect

HIV/AIDS is still an emergency, particularly amongst young men of color ages 15-24 who have sex with men. We need to accelerate our responses across the board, employing all of the HIV prevention options that have been proven to work in our efforts to decrease the incidence of HIV.

We have a long way to go before we end the epidemic here in the U.S. In Illinois our efforts to increase HIV testing and linking people who are HIV-positive to treatment and care and people who are HIV-negative to an appropriate range of prevention options is the most important thing we can do to address this epidemic. For some people, the range of appropriate prevention options may include pre-exposure prophylaxis (PrEP) and/or post exposure prophylaxis (PEP).

Daily oral PrEP provides partial protection and is not a replacement for other prevention strategies like the male and female condom. Pre-exposure prophylaxis, or PrEP, is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill every day. The pill (brand name Truvada) contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV. When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection. It will not be right for everyone. It requires adherence to the medication, a confirmed HIV-negative diagnosis and ongoing monitoring. Further, there are a number of questions remaining about how PrEP can be implemented in different communities and how it will best be used by those who need it most.

The U.S. Food and Drug Administration (FDA) approval and the World Health Organization (WHO) guidance on PrEP was based on a rigorous review of data from four large-scale clinical trials in different communities. PrEP, like condoms, works when used consistently and correctly. We know that PrEP will never be the answer for everyone at risk of HIV infection, but it is an important new choice in a combination of prevention options that includes male and female condoms, behavior change, harm reduction, and early and consistent treatment for HIV-positive people.

Post Exposure Prophylaxis or PEP, is an emergency treatment that can help reduce your chances of becoming permanently infected with HIV (the virus that causes AIDS) after you have been possibly exposed. PEP is given to people after events that put them at a high risk for HIV infection (for example, unprotected sex or using a dirty needle). Possible exposure to HIV is an emergency. It is important to be treated as soon as possible, as the longer you wait, the higher your chance you will become permanently infected with HIV. Generally, PEP will only be given within 3 days (72 hours) after the event that put you at risk for HIV infection.

It can be confusing to know whether you need PEP or not. You may not know for certain if what you did put you at significant risk or if your sex partner even has HIV. Personnel at an emergency room, clinic or physician’s office can help you assess your risk and whether or not PEP is appropriate. If you had unprotected sex and your partner does not know his or her status, you can ask them to go to the hospital, clinic or physician’s office with you in order to get tested, if they are willing.

After you have informed the triage nurse or receptionist that you might have been exposed to HIV and need PEP, you will be taken to a room to consult with a health care provider who will discuss your situation with you. If it is determined that you are at significant risk for HIV infection and are still within the time limits for PEP, some or all of the following may happen:

  • You will be given a starting dose of antiretroviral drugs
  • You will take a baseline HIV test (to determine if you are already infected)
  • The physician may order a Hepatitis B antibody test to make sure you have significant immunity to Hepatitis B, if not he or she may give you a Hepatitis B vaccine
  • The physician may order liver function and other necessary blood tests to make sure you can safely take antiretroviral drugs
  • You will be given a prescription for 28 days of antiretroviral therapy
  • You will be scheduled for a follow-up appointment

Some hospitals and clinics might also give you a “starter pack” of several days’ anti-retroviral therapy so that you can continue your therapy in the event that you cannot get your prescription filled rapidly.

In Illinois, many insurance plans, including Medicaid, cover PrEP and PEP.

There are no magic bullets! PrEP nor PEP, like any strategy, won’t end the epidemic alone, and certainly not with the current, poor rates of HIV testing and linkages to care or even access to male and female condoms. The best-case scenario is one in which people are choosing from a menu of options throughout their lives.

Today, eight million people around the world are receiving HIV treatment. We can and must provide access to PrEP/PEP for those who need it.

For more information on PrEP: http://www.cdc.gov/hiv/basics/prep.html

For more information on PEP: http://www.cdc.gov/hiv/basics/pep.html

For information of PrEP Providers/Resources in IL: http://www. prep4illinois.com

For National PrEP resources: https://preplocator.org/

If you’re a Medical Provider seeking guidance: Clinician Consultation Center http://nccc.ucsf.edu/

For more information on HIV Education, Prevention, and Care in Illinois, please visit: www.hivcareconnect.com

Chris Wade, HIV Care Connect Project Coordinator

Illinois Public Health Association, HIV Care Connect

CWade@ipha.com

(309) 453-9042 mobile

www.hivcareconnect.com

HIV Care Connect is a program of the Illinois Public Health Association and is funded by the Illinois Department of Public Health