Posted 23 April 2017
What is PrEP?
PrEP (Pre- exposure prophylaxis) can be taken by people who are negative for HIV before sex to prevent them from contracting HIV (Human Immunodeficiency Virus). (1)
The results of clinical trials have been very successful, reporting that PrEP significantly lowers the risk of becoming HIV positive. (2)(3)
The medication used for PrEP is a tablet called Truvada which contains tenofovir and emtricitabine. These are drugs commonly used to treat HIV in the UK.
PrEP has been shown to be highly effective at preventing HIV as long as it’s taken as directed but it is important to note that it will not protect you from other STIs (sexually transmitted infections) and so it’s still vital to practise safe sex by using a condom. It is also important to go for regular STI screening every three months so you can get tested and treated if necessary.
Before PrEP
It is essential to have an HIV test before you start taking PrEP as it can only be used if you are HIV negative. If you take PrEP without being tested and find out later that you are HIV positive then you could develop resistance to the drugs that you will need for successful treatment.
You should also be tested for the Hepatitis B virus before you start PrEP, as although you can still take the medication, its use needs to be monitored more carefully and medical advice is needed, particularly if you decide to stop taking it at any point.
It is also important to check your kidney function both before starting the medication and every 3 months thereafter. Initially to assess your kidney function, a blood test is used to measure the level of creatinine in the blood as this is an indicator of how well your kidneys are working. If the kidneys become impaired for any reason, the creatinine level in the blood rises due to poor clearance of creatinine by the kidneys. Doctors routinely use creatinine levels to check kidney function and this is one of the most accurate ways of monitoring them.
During PrEP
Whilst taking PrEP, you should have a HIV test and a urine protein dipstick test every 3-4 months to reaffirm that you are still HIV negative and to ensure that the PrEP medication is not having an adverse effect on your kidney function. The urine test is an alternate way to measuring kidney function that is not as specific as the creatinine blood test needed before starting the medication, however it is a reliable and simple way to quickly determine if there are signs of kidney injury.
If the dipstick test detects any protein in your urine then it’s a sign that your kidneys might be affected by taking PrEP and you should make an appointment with your GP or other healthcare provider or attend a local sexual health clinic. They will perform further tests that are able to determine the exact cause of the result and can inform you as to whether the medication is still safe to take. You can buy a urine protein dipstick test kit at your local pharmacy.
Also, every 12 months you should repeat the HIV test along with the creatinine blood test for accurate kidney function levels to ensure that there has been no change since commencing the medication.
Therefore, before taking PrEP, you should be tested for HIV and Hepatitis B (HBV) and have your kidney function checked.
While taking PrEP, you should have a HIV test and a urine protein dipstick test every 3-4 months.
Every 12 months, a HIV test and a kidney function check should be carried out again to ensure that there has been no change since commencing the medication.
Since these health checks are of such importance both before taking PrEP and while you are taking it, we at WebMed Pharmacy have introduced the following three tests;
Medically reviewed by: Super intendent pharmacist Margaret Hudson BSc(Hons)MRPharmS
1) PrEP pre-treatment test kit :- tests for HIV, Hepatitis B (HBV) and measures your baseline kidney function.
2) HIV test kit :- to be used every 3-4 months.
3) Annual PrEP test kit :- this will check that you are still negative for HIV and measures your level of kidney function.
References;
(1) Terrence Higgins Trust. PrEP (Pre-exposure Prophylaxis) Terrence Higgins Trust [Internet]. Tht.org.uk. 2017 [cited 23 April 2017].
Available from: http://www.tht.org.uk/sexual-health/About-HIV/Pre-exposure-Prophylaxis
(2) Aids Map. PROUD PrEP study results published [Internet]. Aidsmap.com. 2017 [cited 23 April 2017].
Available from: http://www.aidsmap.com/PROUD-PrEP-study-results-published/page/2998033/
(3) BASHH. Updated BHIVA-BASHH Position Statement on PrEP in the UK [Internet]. 2017 [cited 23 April 2017]. Available from: https://www.bashh.org/documents/PreP_BHIVA_BASHH_Update_14June15_for%20consultation.pdf
Medically reviewed by: Superintendent pharmacist Margaret Hudson BSc(Hons)MRPharmS 23/04/17
Posted in Sexual Health