PrEP

PrEP is the acronym for pre-exposure prophylaxis.

Although pre-exposure prophylaxis (PrEP) - the use of antiretroviral drugs by uninfected individuals to prevent HIV infection - is a promising prevention option, important public health issues remain unresolved.

The daily oral use of emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF) is highly effective in preventing HIV infection in people at risk due to sexual contact. There is good evidence of efficacy in women and men and in men who have sex with men when using event-related dosing.

Oral FTC-TDF is extremely safe, has minimal effects on kidney, bone or pregnancy outcomes, and there is no evidence that its efficacy has been reduced by risk compensation during open-label and programmatic follow-up.

Pre-exposure prophylaxis (PrEP) is used to prevent HIV infection. There are two main active ingredients used in PrEP: tenofovir disoproxil (TDF) and emtricitabine (FTC). These are usually contained in a fixed combination in a tablet, e.g. as ^Truvada® or generics.

There are two established methods of administration:

1. daily intake (Daily PrEP):

• Dosage: 1 tablet daily (contains 300 mg TDF + 200 mg FTC)
• Target group: People at regular risk of HIV (e.g. men who have sex with men (MSM), trans people, heterosexual people)

2nd event-related intake (on-demand or 2-1-1 regimen):

• Dosage: 2 tablets (600mgTDF+400mgFTC)24-2 hours before sex
• 1 further tablet 24 hours after taking the 1st tablet
• 1 further tablet 48 hours after taking the 1st tablet
• If sex continues, it is advisable to continue taking the tablets daily until 48 hours after the last sexual intercourse.

The human immunodeficiency virus (HIV) continues to pose a major challenge to global health, with millions of people affected and new cases emerging every year. Despite significant advances in HIV research, the field of HIV vaccines faces numerous challenges. The study results are not yet evident (Kaur A et al. 2024).

In this respect, pre-exposure prophylaxis (PrEP) is currently of great importance. It is still too early to assess the impact of this treatment on the incidence of sexually transmitted infections (STIs) at population level. Access to pre-exposure prophylaxis is limited and inequalities exist, including those based on ethnicity and gender. The optimal combined prevention program needs to be defined, depending on local epidemiology, coverage and cost-effectiveness (Desai M et al. 2017).

1. Desai M et al. (2017) Recent advances in pre-exposure prophylaxis for HIV. BMJ 359:j5011
2. Kaur A et al. (2024) Exploring HIV Vaccine Progress in the Pre-Clinical and Clinical Setting: From History to Future Prospects. Viruses 16:368.
3. Tumarkin E et al.(2019) HIV pre-exposure prophylaxis (PrEP). BMJ 364:k4681.