To know more on PrEP - Pre-Exposure Prophylaxis

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PrEP – Pre-Exposure Prophylaxis

This article is part of RÉZO’s “Keeping you informed” campaign launched in June 2015 and focuses on viral load (lower), PrEP and PEP. This information campaign will be seen in the magazine Fugues during the summer of 2015, on Grindr and in different establishments in the Gay Village of Montréal.

 

 

 

 

What is PrEP?

 

 

PrEP is an additional tool used to prevent HIV for HIV negative individuals.

 

PrEP is an acronym for Pre-Exposure Prophylaxis. The acronym in French is PPrE (prophylaxie préexposition).

 

A prophylaxis is a means of preventing an infection. Pre-exposure means before being exposed to the risk of infection.

 

PrEP, for HIV, consists of taking an antiretroviral pill when you are HIV negative to minimize the risk of HIV infection through potential exposure (sexual intercourse with anal penetration, etc.). The medical world already uses this concept for different diseases (Malaria protection for travellers for example).

 

The drug needs to be sufficiently concentrated in your body to prevent the infection of HIV. It has been shown that only taking one pill 10 minutes before sex is not enough.

 

You have to keep in mind that PrEP does not prevent against other STIs like gonorrhea, chlamydia, hepatitis C, syphilis, etc. It is therefore important to use PrEP in combination with other STI prevention methods, such as: condoms and lube, regular and frequent STI testing (you can consult websites like Jack & Jacques or Ready for action as an online tool for testing reminders), disclosure with your partners, etc.

 

 

 

 

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How does PrEP work?

 

 

When there are sufficient levels of the drug present in your body (i.e. when it is concentrated enough), it slows down HIV‘s ability to reproduce during exposure.

 

More specifically, the molecules of the antiretroviral block the virus’ attempt to attack white blood cells which it uses to replicate itself. Keep in mind that white blood cells exist to protect you against infections. HIV works to destroy white blood cells, a process which PrEP blocks or works against. You can watch a video to see how this happens from whatisprep.org by clicking here.

 

Once again, for PrEP to be successful, you must take it before, the day of, and after risky sexual behavior. See section 'Should I be taking PrEP daily, or on an on-demand basis?".

 

When we are using the term 'at risk', it is describing a situation where your body may have been in contact with HIV. Kissing an HIV positive friend is not a risk! There are various modes of transmission of HIV: by human bites or by being exposed to blood or genital secretions on a mucus membrane (eye, nose) or on skin where there is an unhealed wound or scrape (entry point into the body). It is also possible to be pricked accidentally by the needle of an unknown person found lying around.

 

To this day, the only treatment officially recognized for PrEP is a mix between two antretroivirals in one tablet: Truvada®. They are the same kind of drugs that people living with HIV take.

 

 

 

 

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How effective is PrEP?

 

 

Many clinical studies have been done to verify the effectiveness of PrEP. For high risk men, PrEP greatly diminishes the risk of HIV transmission.

 

These studies have looked at both clinical effectiveness as well as their effectiveness in day to day life. The defining factor is adhesion: taking the medication diligently and in the right way (as prescribed).

 

For example:

 

  • Recently, the French clinical study ANRS-IPERGAY (in which RÉZO was a partner for the Quebec site), confirmed that PrEP taken on-demand (taken specifically only within the period surrounding sexual encounters) decreases the risk of HIV infection by 86%;
  • The British study PROUD, confirmed that taking PrEP continuously every day decreases the risk of HIV infection by 86%;
  • In the United States, the CDC (Centers for Disease Control and Prevention) acknowledge that high risk men taking PrEP continuously every day would decrease the risk of HIV infection by 92% ;
  • More recently, the results of iPrEX OLE demonstrated that men that take PrEP diligently (minimum 4 to 7 times a week) has an effectiveness estimated at 86% to 99.9%!

 

In conclusion to these studies, what they all point to is this: the more consistently a person takes PrEP, the more efficient PrEP is in preventing HIV.

 

That being said, it is always difficult to talk about "the actual risk" of being infected by HIV. Risk may vary according to the viral load of your partner and your sexual practices. Do not hesitate to contact RÉZO to learn more about what you should consider in evaluating the risk of HIV infection according to your sexual practices.

 

PrEP is not a drug that is sold over the counter. It needs to be prescribed by a doctor who will provide regular follow-ups.

 

 

 

 

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What are the side effects of PrEP?

 

 

To this day, taking Truvada® to prevent HIV is safe and is generally well tolerated by patients.

 

This drug can cause gastrointestinal side effects, such as nausea, cramps, etc. These side effects are often temporary and we usually see them mostly during the beginning of the medication. This is due to the body's adjustment to a new medication and for most people these side effects go away quickly. In rare cases, Truvada® may have an effect on kidneys and/or bones. These side effects are far less common and are generally reversible.

(Source : Avis intérimaire sur la PrEP prise en continu du ministère de la Santé et des Services sociaux du Québec)

 

 

 

 

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How much does it cost to be on PrEP?

 

 

Without insurance (public or private), the monthly cost for PrEP on a daily basis (30 pills per month) is between $907 to $995.

 

If you are covered by the Régie de l'assurance maladie du Québec (RAMQ), PrEP is covered under your plan. Unless you have received an exemption, the maximum fee per month (in 2015) is $83.33. You can consult the RAMQ website for more details. If you are currently taking prescribed medication, it won't cost you more than the maximum fee; the rest of your medication will be covered entirely.

 

For people with private insurance, it depends on the insurance policy. Generally, annual coverage starts on January 1st. The refunds can vary depending on your plan. You need to keep in mind that every insurer has a maximum fee that you will need to pay. In Quebec, these scales are determined by the government. You will find this maximum fee in your insurance policy.

 

In both cases, PrEP is essentially covered here in Quebec.

 

 

 

 

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Is PrEP for me?

 

 

PrEP is an extra tool to help prevent HIV. It is ultimately up to you to decide if it suits your lifestyle and needs in regards to sexual behavior that may put you at risk of contracting HIV.

 

Typically, PrEP is meant for HIV negative men that engage in risky sexual practices with HIV positive men or with partners whose statuses are unknown. PrEP can also be used by HIV negative men that are in a relationship with an HIV positive man who has a detectable viral load.

 

PrEP can also be used by men that, for whatever reason, do not use condoms consistently.

 

You can discuss the possibility of using PrEP, your tolerance to the medication, and your risk level with a doctor or a nurse. You can also talk about your sexual health with a RÉZO counsellor who would be able to refer you to other resources if you need them.

 

Don’t forget that PrEP doesn’t protect you from other STIs. It is highly recommended that you use additional protection strategies when you engage in sexual activities. For example, if you don’t consistently use condoms when having sex, it is strongly recommended to get tested every three months for STIs.

 

 

 

 

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Should I be take PrEP daily or on an on-demand basis?

 

 

To this day, two protocols have been proven to be effective when taking PrEP: taking it every day (continuously) or taking it when needed in prevision of a period of sexual activity (on demand). In both cases, it is the same prescribed drug.

 

Daily PrEP: This protocol is approved in the United States by the Food and Drug Administration (FDA). The drug is used every day, at the same time, so that it is firmly integrated inside of your system (at a high level of concentration).

 

PrEP on demand: The drug is taken at a certain moment before, the day of, and after a sexual encounter or period. In the ANRS-IPERGAY essay, PrEP usage was tested 2-24 hours prior to a potential exposition of HIV and for the following 48 hours.

 

In any case, it is with your doctor that you will be able to discuss which protocol is most suitable for you.

 

 

 

 

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Who can decide if I can be on PrEP or not?


 

The decision of taking PrEP starts with you: you need to be comfortable to talk about it openly with a doctor. You will be able to see together if this strategy is suited to your needs, if there are any contraindications between PrEP and any other medications that you may already be taking, and what clinical follow up will be required.

 

To make your consideration on the matter easier, you can also discuss PrEP with a nurse while getting tested for STIs. Share with them the types of risk present in your sex life and the potential benefits that being on PrEP could bring to your sexual health.

 

Only a doctor can perform your evaluation and give you a prescription for Truvada®.

 

RÉZO counsellors are available to talk about whether PrEP is suitable for you or not.

 

 

 

 

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Where can I Have access to PrEP?

 

 

However, it is possible to have access to it through your family doctor if you have one, or any doctor in Montréal that accepts prescribing Truvada® with the goal of preventing an HIV infection.

 

Here are some clinics that are specialized in sexual health that offer PrEP:

 

*We highly recommend that you call in advance and make sure to schedule an appointment with a doctor that is open to evaluating a possible PrEP prescription for you.

 

 

Medical Clinic L'Actuel

Address : 1001, boul. de Maisonneuve Est, bureau 1130, Montréal

Telephone : 514-524-1001.

 

Medical Clinic OPUS

Address : 1470 Peel, Tower A, 8th floor, Suite 850, Montréal,

Telephone : 514-787-6787

 

Medical Clinic Quartier Latin

* if you don’t have a family doctor, the appointment is with an STI screening nurse.

Address : 905, boul. René Lévesque Est, Montréal.

Telephone : 514-285-5500.

 

Clinique SIDEP+

Address: 1705, de la Visitation, Montréal

Telephone: 514-527-2361, ext. 1661.

 

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What is the difference between PrEP and PEP?


 

As explained previously, Pre-Exposure Prophylaxis (PrEP) is taking a preventive medicine before exposition to HIV to reduce the risk of infection. Post-Exposure Prophylaxis (PEP) is taking a medication after being exposed to HIV. PEP is then another HIV prevention method that an HIV negative individual can take after being exposed to HIV to minimize the risk of the virus integrating itself to your immune system. This medication needs to be taken within a maximum of 72 hours of being at risk of contracting HIV. The sooner, the better, as the medication becomes less effective with each hour that passes! In the case of PEP, antiretrovirals are also used, but for a month (28 days).

 

Click here for more information about PEP.

 

 

 

 

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You want to talk about your situation and about PrEP with a RÉZO counsellor?


 

 

Staying informed is giving yourself the chance to make the best decisions for you. Below you will find different internet resources that were consulted as well as complimentary information. Don’t hesitate to call one of RÉZO’s outreach workers at 514-521-7778, ext. 226 or contact us by email: info@rezosante.org or via Facebook.

 

 

 

 

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The resources consulted for this article and other additional resources:

 

 

 

Whatisprep.org (video)

Men.prepfacts.org

The Stigma Project

Project Inform

Centers for Disease Control and Prevention (PrEP)

Demystifying HIV Pre-Exposure Prophylaxis de YOUREKA Science (vidéo explicative)

 

Here are a few French references:

 

La PPrE dans le « vrai monde » : résultats de l’essai de prolongation ouvert iPrEX (CATIE)

La stratégie de PrEP « sur demande » est fortement efficace pour les hommes gais qui ont des rapports sexuels fréquents (CATIE)

L’utilisation quotidienne du Truvada en PrEP est fortement efficace chez des hommes gais dans le projet de démonstration PROUD (CATIE)

Cours 101: IPERGAY et prophylaxie préexposition (RÉZO)

Avis intérimaire du ministère de la Santé et des services sociaux

 

 

 

 

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