PrEP

PrEP (pre-exposure prophylaxis) is a medication (an antiretroviral) that HIV-negative people can take to reduce their risk of getting infected with HIV.

What does pre-exposure prophylaxis mean?

‘Pre-exposure’ means ‘before coming into contact with’ something, in this case the infection HIV. ‘Prophylaxis’ is a treatment that protects you from getting an infection.

What is an antiretroviral?

Antiretrovirals are a combination of drugs used to treat or prevent HIV. They do not cure HIV but prevent further growth and spread of the virus, helping people with HIV live longer and healthier lives.

What is PrEP is used for?

PrEP is used by people who have a high risk of getting HIV. The medication is taken to prevent contracting the infection.

What kinds of PrEP are there?

There’s currently only one type of PrEP available. The branded form is known as Truvada. The unbranded ‘generic PrEP’ is known by the names of the active ingredients in the tablet: emtricitabine and tenofovir.

Both the branded and unbranded versions of PrEP contain the same amount of active ingredients and work in the same way.

Truvada is mostly prescribed in the US. You’re more likely to be prescribed generic PrEP in the UK.

What’s the difference between PrEP & PEP?

While PrEP refers to pre-exposure prophylaxis, PEP stands for post-exposure prophylaxis. PEP is taken after you’ve been exposed to a possible risk of getting HIV.

PEP is prescribed for a month, ideally started 24 hours after exposure to HIV. It’s available from sexual health clinics, but also A&E departments so it can be accessed outside of normal working hours.

When taken as prescribed, PrEP is almost 100% effective at providing protection from HIV.

ZAVA can prescribe PrEP to men or women aged over 18 years old, who have tested HIV negative and have a higher risk of getting HIV.

You might have a higher risk if you do not use condoms when having sex with someone whose HIV status is not clear to you, and you’re:

• a man who has sex with men
• a transgender person who has sex with men
• a woman who has sex with bisexual people
• having sex with someone from a country with a high rate of HIV

You also might have a higher risk of getting HIV if you:

• are having sex with someone who is HIV positive and has a detectable viral load (the amount of the virus in their blood is able to be found)
• are taking drugs using needles and sharing those needles with others
• are a sex worker
• get STIs (sexually transmitted infections) on a regular basis

There could be other reasons not listed here that put you at a higher risk of getting HIV.

For ZAVA to prescribe PrEP, we'll need to know that you've tested negative for:

• HIV
• kidney function (creatinine and estimated Glomerular Filtration Rate; eGFR)
• hepatitis B and C

Our Full pre-PrEP test kit covers all of these.

If you already know your hepatitis status, or have been vaccinated, we offer a Basic pre-PrEP test kit that includes tests for:

• HIV
• kidney function (creatinine and estimated Glomerular Filtration Rate; eGFR)

It's also recommended that you do an STI screen at this stage. ZAVA offers the following STI screening kits:

• men who have sex with men STI screen
• men who have sex with women STI screen
• women's STI screen

Why is it important to be HIV negative before and during PrEP therapy?

PrEP contains two types of antiviral drugs. These are also used in combination with other medicines to treat patients who are HIV positive.

Using them on their own when you’re HIV positive can mean you become resistant to them which would make treating the infection in the future more difficult.

How long after having unprotected sex should I test for HIV?

There are different tests for HIV, with different timeframes for testing after unprotected sex. It is important to follow the instructions of each test to make sure the results are accurate.

ZAVA’s HIV test kit is over 99% accurate at detecting HIV if you test four weeks after possible exposure to HIV. You can test at any time before that but if you get a negative result, you should test again to make sure that your results are accurate.

You’ll need to get tested for HIV every three months if you’re taking PrEP.

If you have flu-like symptoms like fever or a rash after unprotected sex, you should not start PrEP until you have confirmed you’re HIV negative. You may need to start post-exposure prophylaxis (PEP), so you should speak to a doctor either in A&E or the nearest sexual health clinic, immediately.

Why is it important to know my kidney function before and during PrEP therapy?

PrEP contains two antiviral drugs, emtricitabine and tenofovir, which are used by the body and then passed out in your pee through your kidneys.

If there are problems with your kidneys, the drugs can build up in your body and cause damage. It’s important to check your kidneys are working properly before starting PrEP, and once a year while you’re taking it.

If you’re taking PrEP and are over 40 years old, or have medical conditions known to cause kidney damage like high blood pressure and diabetes, you should check your kidney function every six months.

You do not need to take PrEP if you have a low risk of getting HIV.

If you’re HIV positive, or you’re not sure if you have HIV, you should not start taking PrEP.

If any of the following factors affect you, it may not be suitable to take PrEP. Talk to a doctor if you have a high risk of getting HIV and want to find an appropriate way to protect yourself.

• you’re under 18 years old
• you have liver disease
• you have kidney disease
• you have an allergy to any of the ingredients in emtricitabine/tenofovir
• you’re taking any other type of antiviral medication
• you’re taking a regular high dose of painkillers
• you have any rare conditions relating to lactose intolerance
• you’re on a low phosphate diet
• you’re pregnant, breastfeeding, or trying to have a baby

You can order prescription PrEP medication online from ZAVA if you’re at a higher risk of getting HIV.

It’s also possible to get PrEP on the NHS, but whether you’re eligible depends on your risk and where you live.

Buy PrEP online

At ZAVA, we offer a complete PrEP therapy service which works in the following way:

1. Fill out our online questionnaire. This will ask you for all of the information our doctors need to decide if they can prescribe you PrEP
2. If you’ve not already had an HIV, kidney function, and hepatitis B and C tests, we can send test kits to you, so you can test at home
3. We can also send you an STI test kit which you can also do at home
4. Our doctors will be in touch once you’ve started taking PrEP to give you any advice or extra information you might need
5. We will offer regular reminders about keeping your tests and medication up to date

You can contact our doctors for free at any time during your treatment if you need any help or support.

Get PrEP on the NHS

Certain people can get PrEP free on the NHS. Each country in the UK has different availability.

In England, the NHS is offering the medication as part of a clinical study called the Impact Trial. You can find out more about joining the trial here or by contacting any of the sexual health clinics closest to you.

If you live in Scotland, Wales, or Northern Ireland there are no limits on the amount of people that can access PrEP, but it is only available at particular clinics and there is an eligibility criteria you must meet before you it will be prescribed to you.

The NHS offers HIV testing free of charge to anyone, and a lot of clinics can give you same-day results. Home test kits are also available on the NHS for free.

You can get HIV testing for free at any of the places below:

• sexual health clinics
• some GP surgeries
• some contraception and young people's clinics
• local drug dependency services
• an antenatal clinic, if you're pregnant

Other ways to get PrEP

Other ways you can get PrEP include:

• Charities like The Mags Portman PrEP Access Fund
• Private walk-in clinics

PrEP contains two drugs that are used to prevent HIV infection. The drugs enter the immune cells in the body. They work by stopping the virus from multiplying and invading other cells in the body.

Your sexual partner does not need to also take PrEP for it to work effectively in reducing your risk of getting HIV.

Is PrEP effective after exposure?

If you’ve come into contact with HIV, and you’re taking PrEP as prescribed, you should be protected from the virus.

If you’re not currently taking PrEP and you think you’ve been exposed to HIV, you should not start taking it. You should go to a sexual health clinic, or if that’s not possible, A&E. You may need to start taking post-exposure prophylaxis (PEP).

You take one tablet a day, preferably with food at the same time every day.

Other important points to note about taking PrEP include:

• It takes about four days for PrEP to start working in men and up to seven days for women
• If you forget to take your PrEP and remember within 12 hours of when you usually have it, take the tablet. If you remember after 12 hours, take the next dose as usual the next day
• If you take more than your prescribed pills, go to your nearest sexual health clinic, or call 111
• It’s not advisable to randomly start and stop PrEP without talking to your doctor first. If your situation changes and you want to take a break, it’s recommended that you still take PrEP for up to seven days after your last exposure to HIV
• If you stop taking PrEP, studies have shown that it may still help reduce your risk of HIV infection by over 90% for up to seven days

PrEP generally causes little to no side effects when used correctly. For those who do have side effects, they usually clear up within a few weeks.

Common side effects of taking PrEP include:

• feeling sick and being sick (vomiting)
• diarrhoea
• headaches
• dizziness
• feeling weak
• pain in the stomach
• feeling bloated
• problems with sleeping
• rashes or swelling of the skin

Less common side effects include:

• anaemia (a lack of red blood cells, or haemoglobin, in the blood)
• muscle weakness and pain
• yellow and itchy eyes
• pain in the bones
• joint stiffness
• back pain
• a condition called lactic acidosis where lactic acid builds up in the body causing drowsiness and difficulty with breathing

If you experience any serious side effects, you should visit A&E immediately.

When filling in our online assessment or talking to your doctor about PrEP, make sure you state all medicines you’re taking, including over-the-counter medications.

You should also talk to your GP or contact ZAVA if you start taking any new medicines while taking PrEP.

It’s particularly important to tell your doctor if you’re taking any of the following medications as they may cause damage to your kidneys when taken with PrEP:

• antivirals
• antibiotics
• painkillers like ibuprofen
• cancer drugs
• hepatitis C medications
• medicines for fungal infections

You can keep taking PrEP if you’re having hormonal therapy.

For information on other medications, you can use an HIV drug interactions checker.

Although PrEP is highly effective at reducing the chance of getting HIV, there are a few existing and new ways that also offer protection against catching the virus.

Using condoms

Condoms offer one of the most effective forms of protection from getting HIV, when used correctly. They will also protect you against other STIs. It’s important to put on a condom before any sexual contact happens between the vagina, penis, anus, or mouth.

You can get free condoms on the NHS from some GP surgeries and sexual health clinics, or you can buy them online or from pharmacies and supermarkets.

Needle exchange programmes

If you’re an intravenous drug user, you have a higher risk of getting HIV and other infections like hepatitis C when you share needles with other users.

In the UK, there are local authorities and pharmacies that have needle-sharing programmes where you can exchange your used needles for clean new needles, reducing your risk of catching HIV and other infections.

HIV prevention implant

A new PrEP implant trial has been carried out on a small group of people with the aim of replacing the current PrEP tablets. The implant is put under the skin and works by regularly releasing a small amount of the drugs. So far the trial has found that the implant could last for up to one year.

Recent research has shown that people with an undetectable HIV viral load (the amount of the virus in their blood is not able to be found), cannot pass on the virus to others.

The PARTNER 2 study found that people taking effective HIV treatment with an undetectable viral load, did not pass on the virus to their sexual partners.

If you’re starting or currently taking PrEP, there are a few things you need to do regularly to make sure you stay healthy while taking the drugs.

Every three months while taking PrEP

For ZAVA to continue to prescribe PrEP, we'll need to know that you've tested negative for:

• HIV
• kidney function (creatinine and estimated Glomerular Filtration Rate; eGFR)

Our Three-monthly PrEP test kit covers both of these.

Once a year while taking PrEP

For ZAVA to continue to prescribe PrEP, we'll need to know that you've tested negative for:

• HIV
• kidney function (creatinine and estimated Glomerular Filtration Rate; eGFR)
• hepatitis B and C

Our Annual PrEP test kit covers all of these.

On a regular basis

We'd advise having an STI screen. ZAVA offers the following STI screening test kits:

• men who have sex with men STI screen
• men who have sex with women STI screen
• women's STI screen

You can also buy the following test kits from ZAVA:

• HIV
• HIV, syphilis, and hepatitis B and C

Further helpful information

Depending on your current situation and needs, there are several options which can offer you more information and support regarding other areas of your life:

• if you’re transgender, you can get more information and support from Mermaids
• the NHS has information about psychological therapies
• the Gay men’s health project offers information about HIV prevention and works to fight against HIV stigma
• you can find out more information and support on drugs and chemsex from your local sexual health clinic or on Dean Street Clinic’s website

• 1995: first PrEP experiment
• 2012: PrEP launches in US
• 2014: PrEP launches in UK
• 2017: NHS starts providing PrEP in England, Wales, Scotland
• 2018: HSC starts providing PrEP in NI