Health | PrEP
Pre-Exposure Prophylaxis (PrEP) Dr. Shay Keating writes about the advantages and disadvantages of Pre-Exposure Prophylaxis in the treatment of HIV Prophylaxis, in medical terms means preventing a disease or condition. Post-exposure prophylaxis (PEP) is any prophylactic treatment started after an exposure to a disease. PEP is currently licensed under strict specialist supervision following HIV exposure either sexually or needle stick. Pre-exposure prophylaxis (PrEP) on the other hand is a medical or public health procedure used before an exposure to prevent a disease rather than treat or cure it. For example, a doctor might give medication used to treat a specific disease to a healthy person who is believed, not have the disease but to be at risk of contracting it. A well known and commonly used example of PrEP is malaria medicine, given to travellers to countries where the disease is endemic such as Sub Saharan Africa. PrEP is currently used in serodiscordant couples where one partner is HIV positive and the other negative and where the woman is keen to become pregnant. PrEP is used by the negative partner for a defined 46 EILE Magazine
time around the planned time of conception is a powerful tool to limit HIV infection from sexual intercourse. This has lessened the need for specialist and expensive sperm washing or artificial insemination in many cases. What about using PrEP indefinitely as a HIV prevention tool? In 2007 the iPrEx study enrolled 2499 individuals to take part in a clinical trial. The trial involved 6 counties worldwide including the United States. This was the first trial to study the effectiveness of continuous PrEP use in preventing HIV infection. All participants in the study received monthly HIV testing, safer sex counselling, condoms and STI treatment where appropriate. Half of the participants received a popular antiretroviral therapy (ART) and half received a placebo. The results of this study were interesting. There was a 43.8% reduction in HIV infection in those taking ART. This research was hailed by Time Magazine as the ‘most significant medical
breakthrough of 2010’. It has been estimated that taking ART every day would be 99% effective in preventing HIV infection. This is comparable to consistent and careful condom use, which apart from abstinence has up to now been the best sexually acquired HIV prevention strategy. Condoms can slip off or break and that’s when one remembers to use one.
The early PrEP data seems very promising but there are some problems. Adherence to PrEP is essential. The Centre for Disease Control (CDC) in Atlanta Georgia had a more tempered response to iPrEx. They argued that PrEP has been shown to reduce HIV infection among men who have sex with men (MSM) and not heterosexuals or injecting drug users. The TDF2 trial in Botswana however, showed a 63% reduced risk of HIV infection in heterosexual men and women. Used correctly, PrEP appears to
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