Pre-Exposure Prophylaxis (PrEP) represents an important breakthrough in HIV prevention. This approach involves HIV-negative people taking antiretroviral drugs to prevent infection before exposing themselves to risky situations.
What is PrEP and Who Can Benefit from it?
PrEP is especially recommended for individuals who have high-risk sexual behaviors, such as those who do not consistently use condoms and have casual sex with potentially infected partners.
Although initially designed for these groups, PrEP is now considered a valid prevention tool for everyone, regardless of risk level. It is important that anyone wishing to start PrEP first take a fourth-generation HIV test to make sure they are not already infected, thus avoiding the risk of developing drug resistance.
Methods of Taking PrEP
The drugs used for PrEP, Tenofovir and Emtricitabine, are combined in the drug Truvada and its generic equivalents. There are two main modes of intake:
- Continuous: One tablet per day, ideal for those who have frequent, unplanned sexual intercourse. It is necessary to start several days before potential exposure to the virus to ensure optimal protection.
- Intermittent (On Demand): Consists of taking two tablets between 2 and 24 hours before intercourse, followed by one tablet after 24 hours and another tablet 48 hours after intercourse. This method is suitable for those who have less frequent and planned intercourse, but is not recommended for those practicing receptive vaginal sex because of the longer time required to reach protective levels in vaginal tissues.
Efficacy and Limitations of PrEP
When taken correctly, PrEP is extremely effective in preventing HIV, reducing the risk of infection to almost zero. However, it does not offer protection against other sexually transmitted infections (STIs) such as gonorrhea, syphilis or chlamydia. For this reason, it is critical to combine PrEP with other preventive measures, such as condom use and regular STI screenings.
Side Effects and Health Considerations
PrEP is generally well tolerated, with short-term side effects including nausea, diarrhea, and headache usually resolving within a few weeks. In the long term, it can affect kidney function and bone density, so periodic medical checkups are necessary.
Adherence and Resistance
To ensure the effectiveness of PrEP, strict adherence to the prescribed regimen is crucial. Non-adherence can reduce efficacy and increase the risk of infection and development of drug resistance. Regular HIV testing during PrEP use is also essential to monitor serologic status and prevent resistance.
Interactions with Other Drugs
PrEP can interact with some drugs, particularly nonsteroidal anti-inflammatory drugs (NSAIDs), increasing the risk of kidney damage. It is important to inform your doctor about all drugs in use to avoid dangerous interactions.
Starting the PrEP Pathway
Before starting PrEP, various tests are required to ascertain the absence of HIV and assess general health, including tests for hepatitis B and kidney function. Once prophylaxis is initiated, quarterly HIV checks, renal function monitoring every six months, and periodic STI screenings are recommended.
Where to Turn
It is important to start PrEP under the supervision of a specialized center. In Italy, there are dedicated services, such as www.prepinfo.it, which offers information and support. For those who have difficulty accessing local services, LILA Milan offers TelePrEP, a remote prophylaxis management service.
PrEP is a breakthrough in HIV prevention, offering almost complete protection against the virus for those who take it correctly. However, the effectiveness of PrEP depends on strict adherence to the regimen and regular monitoring. Getting informed, obtaining medical support and following prescriptions are key steps to ensure maximum safety and effectiveness of this prophylaxis.
With proper management, PrEP can transform the lives of people at risk, offering robust protection against HIV and contributing to an epidemic-free future.
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