HIV Pre- exposure Prophylaxis (PrEP)- 2 dosing regime options for high risk MSM

The PROUD and IPERGAY studies offer us 2 dosing options for effective HIV prevention in high risk MSM:

1. Daily Truvada (Tenofovir/ Emtricitabine) 1 tablet

or

2. On- demand Truvada at the time of sexual exposure as follows:

- 2 tablets 2-24 hrs before sex

- 1 tablet 24 hrs later

- 1 tablet 48 hrs later

( if additional sexual encounters then continuing the regime so that 2 tablets over 48 hrs are taken after the last sexual encounter)

With the addition of PEP provided on-demand

Some additional considerations:

• Adherence to PrEP is obviously critical to its effectiveness
•  Condom use should continue to be promoted. Although neither study showed an increase in incidence of STIs in the PrEP group there is an ongoing concern that increased risk taking behaviour on PrEP will increase STI incidence.
• Side effects- most commonly GIT - nausea, diarrhoea, less common- headache, renal
• Renal monitoring- baseline and ongoing (? Frequency)
• Baseline and ongoing HIV and STI testing ( 3 monthly)
• Possible targets for PrEP- High risk MSM. For example anyone- with an STI in the last 6 months, in a HIV discordant relationship, who has unprotected anal sex, who use recreational drugs and/or binge drinks.