HIV pre-exposure prophylaxis (PrEP)
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k4681 (Published 17 January 2019) Cite this as: BMJ 2019;364:k4681
- Ethan Tumarkin, resident physician in internal medicine1,
- Mark J Siedner, associate professor of medicine2 3 4,
- Isaac I Bogoch, associate professor of medicine1 5
- 1Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- 2Harvard Medical School, Boston, MA, USA
- 3Massachusetts General Hospital, Boston, MA, USA
- 4Mbarara University of Science and Technology, Mbarara, Uganda
- 5Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Correspondence to II Bogoch isaac.bogoch{at}uhn.ca
What you need to know
PrEP is an effective and proactive form of HIV prevention, in which people who are HIV negative and have active and substantial risk factors for HIV infection take antiretroviral medication to prevent infection
Efficacy of PrEP is highly dependent on adherence
PrEP does not protect against other sexually transmitted infections such chlamydia, gonorrhoea, and syphilis, therefore additional methods of protection (eg, condoms) are necessary
A 22 year old man attends a sexual health clinic. Six months previously, he completed a course of HIV post-exposure prophylaxis for anal receptive intercourse without a condom. Since then, he reports six anal receptive sexual exposures without a condom. He has been treated at another sexual health clinic for rectal gonorrhoea. He asks if you could prescribe him PrEP.
HIV pre-exposure prophylaxis (PrEP) is the use of HIV antiretroviral medicines in people without HIV to prevent infection. When taken correctly, PrEP has been shown to reduce the risk of HIV infection in numerous populations, including young women, men who have sex with men, HIV uninfected members of sero-discordant couples, and injecting drug users.123 Based on this evidence, PrEP is recommended for people considered at high risk of acquiring HIV. However, availability of PrEP and access to expert advice and counselling about its use vary globally. For example, in England it is only available as part of a clinical trial, whereas it is available in the rest of the UK at sexual health clinics. Awareness of PrEP among at-risk groups is growing, and availability of the treatment is becoming more widespread; therefore generalists—as well as those working in sexual health services—require an awareness of the indications, efficacy, use, and potential harms of PrEP.
What you should cover
Identify risk of HIV
Ask the patient about known or potential HIV exposures in the previous six months, particularly sexual exposures or injecting drug …
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