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HIV prevention by pills - PrEp and PEP

While HIV remains incurable, there are ways to reduce the possibility of catching the infection before an exposure to HIV virus has happened and even after a possible exposure. These medication courses are known as PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) respectively.

Before HIV exposure - Use PrEP

Pre-exposure prophylaxis or PrEP is a medication course that is taken before HIV exposure by people who are at risk of being exposed to the HIV virus, such as those in a sexual relationship with HIV-positive partners, sex workers during occupational sex, healthcare professionals, people having sex without condoms or those who might use shared needles for drug use. 

PrEP is only for HIV-negative people who are at risk of catching an HIV infection. PrEP medicine blocks the path of the virus in the body’s bloodstream. This course has to be taken before the potential exposure may happen.  

When to take PrEP? 

To be effective, PrEP medication must be started seven days prior to receptive anal or vaginal sex (by the person getting inserted with a penis) and about 20 days prior to insertive anal or vaginal sex (by the person inserting their penis inside an anus or vagina) and injection drug use.

Before starting PrEP, an HIV test must be done to ensure that the person does not already have HIV virus and also repeat the test every three months even while taking it. If either of these is skipped, it might not be useful to take PrEP. This medicine is to be taken every day, and as prescribed by healthcare providers. 

Health care providers usually prescribe one pill, once a day, every day – with or without food. However, it is also important to note that one should still practise safe sex while on the pill.

What is Truvada? 

Truvada is the name of the drug most commonly used for PrEP. Some people use ‘PrEP’ and ‘Truvada’ interchangeably but it is important to note that Truvada is not the only drug for PrEP. Another such drug is Tenvir EM, which is a composition of two antiretroviral drugs called Tenofovir and Emtricitabine. 

After possible HIV exposure - Use PEP

Post-exposure prophylaxis or PEP is also for people who are HIV-negative, but it is different from those who’re prescribed PrEP in a way that they may have already been exposed to the HIV virus. 

This exposure may happen through various situations like – healthcare workers accidentally getting stuck with needles used on HIV-positive persons, survivors of sexual assault getting infected by an HIV-positive assaulter, sex workers infected during occupational sex, the person who’s had unprotected sex or their condom was accidentally torn and leaked, or if a person has shared needles during recreational drug use.

PEP prevents the HIV virus from developing into an HIV infection inside the person’s body, despite coming in contact with the virus.   

When to take PEP?

PEP, which comes into the picture after a possible HIV exposure has happened, must be started within 72 hours (three days) of such exposure, sooner if possible. The longer the delay in taking PEP medicine after possible exposure, the lower the effectiveness of this medication. 

You must immediately reach out to a medical facility’s emergency upon possible contact with the HIV virus, and request PEP. This course runs for 28 days (four weeks). After the course ends, an HIV test is done as a follow-up to PEP medication, and another test after three and six months, or as recommended by the healthcare provider. 

However, if you are unable to access PEP within 72 hours of exposure, do not panic. Say more than a week has passed since the exposure occurred, it is still worth seeking to visit a health professional to see what your options are.

PEP success rate

The success rate of PEP is 98% if started within 72 hours after the possible exposure to HIV infection. Do not miss any doses of PEP. It may increase your risk of getting the infection. While you only need to take PEP for a month (28 days) but if you do not take the course, you may get infected with HIV and may have to take anti-HIV treatments for a lifetime.

Cost and availability of PrEP and PEP in India 

Yes, PrEP and PEP are available in India. A doctor’s prescription is required to purchase this drug. PrEP or Tenvir EM (the generic or cheaper version of Truvada for PrEP) is manufactured and distributed by Cipla and is available for purchase from major pharmacies across India.

Based on the National Pharmaceutical Pricing Authority of India (NPPA), the MRP price of Cipla Tenvir-EM for PrEP is INR 2500 for 30 tablets.  Apart from the treatment of HIV Infection, the drug is also used for the treatment of chronic hepatitis and B Virus Infection. 

PEP is only available for use in hospitals upon prescription. PEP involves taking a short course of ARV drugs, usually for a month. Zidovudine, Tenofovir and Lamivudine are also some of the drugs that are used in PEP to prevent the spread of HIV.

You can also dial the AIDS Helpline 1097, which was established in 2014, to get details of the nearest hospitals administering PEP pr even ART (antiretroviral therapy) clinics. Other such helplines are listed here.  

One course of PEP treatment costs INR 1000 - 1500. However, your health care provider is the best person to suggest to you how many courses of treatment you need. 

Not fool-proof

It is important to note that, both, PrEP and PEP medication must be taken exactly in the way prescribed by healthcare providers and without missing doses. Despite that, neither PrEP nor PEP is 100 per cent effective in any situation. 

Moreover, they also have side effects, that in the case of PrEP can also be quite serious. Some common side effects are nausea and headaches, though some people will experience no side effects.

So, the best way is to make lifestyle choices that will minimise the risk of coming in contact with the HIV virus in the first place. PrEP and PEP should not be thought of as a substitute for safe-sex practices ( such as the use of condoms that also prevent other STDs)  and abstinence from sharing needles for recreational drug usage. 

Do check out the detailed video Pep and Prep: HIV prevention below: 

Do you have any questions on PrEP and PEP usage or HIV? Please ask LM experts on our discussion forum. You can also visit Love Matters (LM) on our Facebook page. 

Pep and PRep - HIV prevention

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