An Overview of HIV PrEP (Pre-Exposure Prophylaxis)

HIV PrEP is a risk-reduction treatment against HIV which involves the daily consumption of HIV preventive medication. PrEP will be prescribed to HIV-negative patients who are at high risk of acquiring HIV infection after a review by our doctors. In addition, patients on PrEP will be provided with comprehensive sexual health services such as screening for sexually transmitted infections (STIs) and safer sex counselling.

HIV PrEP Medication

Currently, PrEP is a combination of two antiviral medications Tenofovir and Emtricitabine (TDF & FTC). These drugs are approved by both U.S. Food and Drug Administration. They are highly effective in reducing the chances of an HIV-negative person contracting HIV infection. 

Who May Be Suitable for PrEP? 

PrEP may be useful for someone who is HIV-negative and if the person: 

•  Has a partner with HIV who is not on suppressive antiretroviral therapy
•  Is at risk of getting HIV through vaginal/ anal sex with multiple partners without the consistent use of condoms in the last six months
•  Have sexually transmitted infections in the last six months
•  Is a drug user who shares equipment and needles with others to inject drugs

Is PrEP Effective After Exposure to HIV?

PrEP is meant to reduce risk before exposure and is only suited for people with a constant ongoing high risk of acquiring HIV infection. If you have never started PrEP and are recently exposed to HIV, you should consider Post-Exposure Prophylaxis (HIV PEP) within 72 hours after exposure to potential HIV infection. It would be best if you discussed further with our doctor on PEP. 

How to Take PrEP?

1. Daily PrEP

PrEP is very effective if taken daily. Studies have shown that daily dosing of co-formulated TDF/FTC can reduce the risk of getting HIV by about 99% from sex. 

HIV PrEP needs to be taken for seven days before high levels of protection are achieved for both vaginal and rectal exposure to HIV. 

PrEP does not protect against other STIs. Responsible, safe sex and the use of barrier contraception should be practised.

2. On-Demand PrEP

It is recommended in cis-gender men who have sex with men. A double dose (two tablets) of co-formulated TDF/FTC will be taken 2-24 hours before potential sexual exposure, followed by single doses 24 and 48 hours after the initial dose. 

When potential exposure is sustained for more than a 24-hour period, one tablet per day should be taken until the last exposure, followed by the 2 post-exposure tablets. 

Safety & Adverse Side Effects

HIV PrEP does not cause any severe side effects. The common side effects include upset stomach and nausea, but the symptoms are mild and improve over time. However, you should tell your doctor if these or other symptoms become severe or do not go away. 

Starting Your HIV PrEP

First Doctor Consultation

You can discuss with our experienced infectious diseases doctor on HIV and sexual health to decide whether PrEP is right for you.

1. Regular follow-up visits with the doctor are required when you are on PrEP.

Blood tests for HIV, STIs, and baseline renal and liver functions will be offered by the doctor during the first consultation. 

Counselling will also be carried out to ensure medication is taken as prescribed, assess for side effects to the medicine, as well as to obtain a new prescription so that PrEP is not interrupted. Sexual health counselling will also be provided to educate on reducing the risk of acquiring HIV. HIV tests will also be done regularly at 3 to 6-month intervals. 

2. PrEP does not protect one against other Sexually Transmitted Infections.

Condom is the most effective barrier to HIV and is also the best way of reducing one's chances of picking up or passing on other STIs.

HIV blood tests, and STD screening, will be done every 3 to 6 months, with additional treatment depending on patient-reported sexual risk behaviour. Other age-dependent tests for serum creatinine will be offered every 6 to 12 months. 

The need for continued PrEP will be assessed by the doctor and determined based on an assessment of the patient's risk of HIV infection within the past 12 months. 

How About Stopping PrEP?

HIV testing and other relevant tests will be carried out to determine the HIV status and medical conditions such as the Hepatitis B status of the patient.

A patient will also be counselled to reconsider reinitiation of PrEP if the risk of HIV infection should become present again.