PrEP and PEP as a method of HIV prevention
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HIV/AIDS remains one of the world’s most significant public health challenges, particularly in low- and middle-income countries. There were 36.7 million people living with HIV at the end of 2016. An estimated 20.9 million people were receiving HIV treatment in mid-2017. However, globally, only 53% of the 36.7 million people living with HIV in 2016 were receiving ART (WHO statistics).
People are continuously accidentally being exposed to HIV though healthcare work or due to exposures outside healthcare setting, for example, through unprotected sex or sexual assault, among others.
PEP (post-exposure prophylaxis) means taking antiretroviral medicines (ART) by someone who is HIV negative after being potentially exposed to HIV to prevent becoming infected.
These Antiretroviral drugs (ARVs) have been used to prevent infection in case of accidental exposures for many years now. This intervention is called post-exposure prophylaxis (PEP) and involves taking a 28-day course of ARVs.
PEP should be offered, and initiated as early as possible, for all individuals with an exposure that has the potential for HIV transmission, and ideally within 72 hours of exposure.
If started soon after exposure, PEP can reduce the risk of HIV infection by over 80%. Adherence to a full 28-day course of ARVs is critical to the effectiveness of the intervention.
According to WHO, recent evidence shows PEP uptake has been insufficient with only 57% of the people who initiated PEP have completed the full course and rates were even lower at 40% for victims of sexual assault.
For many people that are accidentally exposed to HIV, PEP provides a single opportunity to prevent HIV after exposure. Such accidental exposures may be among health care workers who had needle stick injuries or among adults and children who survived sexual violence.
Access to timely PEP remains challenging in many settings in particular for non-health worker exposures, and this could be greatly due to little public awareness about the availability of such drugs in case of potential exposure to HIV.
Pre-exposure prophylaxis (or PrEP) is when people at very high risk for HIV take Anti-Retroviral drugs daily to lower their chances of getting infected. PrEP is for people without HIV who are at very high risk for getting it such as; people who are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner, HIV negative person with multiple sexual partners, gay or bisexual men who practice anal sex without condoms, and is also recommended for people inject themselves with drugs especially using shared needles.
If one has a partner who is HIV-positive and are considering getting pregnant, talking to their doctor about PrEP if they are not already taking it is important. PrEP may be an option to help protect one and their baby from getting HIV infection while one tries to get pregnant, during pregnancy, or while breastfeeding.
Studies have shown that PrEP reduces the risk of getting HIV from sex by more than 90% when used consistently. Among people who inject drugs, PrEP reduces the risk of getting HIV by more than 70% when used consistently. One can combine additional strategies with PrEP to reduce the risk even further.
It is however very important to know that PrEP doesn’t give any protection against other STDs, like gonorrhea and chlamydia. Also, while PrEP can significantly reduce one’s risk of HIV infection if taken daily, one can combine additional strategies like condom use with PrEP to reduce the risk even further.
Both PEP and PrEP can cause side effects like nausea in some people, but these generally subside over time. No serious side effects have been observed, and these side effects aren’t life threatening. If one is taking PEP or PrEP, it is important to tell their health care provider about any side effects that are severe or do not go away but shouldn’t just stop taking the drug without discussing with your doctor as this limits their effectiveness.
As both PEP and PrEP don’t offer 100% protection against HIV infection, one should continue doing routine counseling and testing for HIV, such as testing for HIV infection after 3 months of exposure in someone who was on PEP.