PrEP 是 Pre-Exposure Prophylaxis (暴露前預防)的縮寫。 這是通過每天服用一粒藥片去保護您免受愛滋病病毒感染的一種方法。
如果您想尝试PrEP，请致电03 9654 6088与George Forgan-Smith博士预约
PrEP 是 Pre-Exposure Prophylaxis (暴露前預防)的縮寫。 這是通過每天服用一粒藥片去保護您免受愛滋病病毒感染的一種方法。
如果您想尝试PrEP，请致电03 9654 6088与George Forgan-Smith博士预约
Quick video to check to ensure you are ordering the correct PrEP online. Be sure to check whether you are ordering generic Truvada or generic Descovy…
Generic Truvada = emtricitabine/tenofovir disoproxil fumarate
Genetic Descovy = emtricitabine/tenofovir alafenamide
Be sure to check you have chosen the correct medication before you hit “order” If you have any questions please feel free to come in and have a chat.
You can book online here: https://isprepforme.com/book
Dr George Forgan-Smith
Great news that Descovy has now been officially approved by the US FDA as it’s 2nd form of HIV prevention medication: PrEP.
Press Release Here: https://www.fda.gov/news-events/press-announcements/fda-approves-second-drug-prevent-hiv-infection-part-ongoing-efforts-end-hiv-epidemic
Descovy has been shown effective in cis males as well as trans females. It has not been approved for cis females or trans males.
Descovy is not yet approved for PrEP in Australia.
Descovy is noted to have less side effects with regards to kidneys. While Truvada PrEP is excellent for many people, it was not recommended for people with reduced kidney function, in particular with a eGFR less than 60. GFR is an estimation of the filtration rate of kidneys.
Descovy is an option for people with reduced kidney filtration.
If you are currently on Truvada for PrEP with no issues, there is no need to change medications.
Descovy is only approved for the treatment of HIV in Australia.
It is available off label for PrEP meaning it can be bought in Australia, at significant cost, or purchased online as a generic. For either option you will require a prescription.
If you feel that this may be an option for you I recommend discussing with your PrEP doctor or local HIV prescribing doctor.
Regards Dr George Forgan-Smith
Full details, video and explaination here: How To Take Intermittent PrEP For HIV Prevention
“transcript”Hey guys, it's Dr. George here. I just wanted to do a brief video to explain the differences between daily prEP and prEP on demand. Here in Australia, both are included as part of the Australian prEP guidelines and both are considered to be highly effective. There are some differences and I just wanted to highlight those. Daily prEP is taken every day. When it's taken every day, we know that it offers really good protection for all people taking it and that's a 99% reduction in risk of HIV infection. Now, there is prEP on demand, also called intermittent prEP. This is for people who either have really bad side effects to taking the tablet every day who may have issues with their kidneys or for people who really aren't having sex that often that would put them at risk of HIV infection. Importantly, we need to note that intermittent prEP is only for men or trans-women. If you own a cervix, if you're female or is you are a male trans-person, then intermittent prEP is not fully studied so we can't guarantee that it's going to be able to ... You have a high enough level of protection against HIV so intermittent prEP only for men, only for trans-women. How does it work? When you feel that you are going to be having sex in a way that could lead to an exposure to HIV, you need to take two tablets of prEP two to 24 hours before you have sex. If you do have sex, then you need to take one tablet of prEP every 24 hours until 48 hours has passed, free of sex. It's very straightforward. Now people are wondering, "What's the efficacy of this?" There has been a recent case in Australia and there were some concerns that is intermittent prEP as effective as daily prEP? As previously mentioned, if you are a trans-male, if you are a female, then absolutely you should be on daily prEP, you should not be using intermittent prEP. Now if we look at the studies, so the IPERGAY Study coming out of France has had two sequential arms, and the first arm showed that it was 87% effective at reducing the risk of HIV. That is, when taken as directed as I just previously described, it would reduce the risk of HIV quite significant, 86%. Now there was a second open study that continued as part of the IPERGAY Study and that number actually rose to 97%. We know that the strategy is effective, it works, and there's a 97% reduction in risk of HIV infection per episode. I suppose the thing is that you need to make a decision about what is going to be best for you but when it comes to daily versus intermittent, if you're having a moderate amount of sex then I would say go with daily. If you're only having sporadic risks of HIV infection, then it's probably best to consider intermittent prEP if you are worried about taking a tablet every day. Some people come to me and they say they're worried about going on holiday, like, they're off to a trip to, I don't know, somewhere and they're thinking, "Well, I would like to have prEP while I'm away." What I would recommend in those situations is you can do either, intermittent prEP or daily prEP. However, if you're going to do the daily prEP, you need to start the daily prEP seven days before you travel, then take the tablet every day during your travel. Then, depending on which study you look at, you need to take it for seven to 28 days after your last potential exposure to HIV. Current guidelines in Australia say 28 days. However, there are studies that say it could be between seven to 28, if you look at recent documents that have been published. Of course, talk with your doctor, this is the important thing. If you are worried or concerned, have a talk to an experienced prEP provider who can provide all of this information for you. I hope this has offered some clarity. I know it's a little bit longer than I expected and a little bit wordier than I expected but please, if you have any questions, come on in, ask away, send me a message and I'll do my best to get an answer for you. I hope this was helpful.
Currently PrEP is available as a generic version of the drug Truvada.
Each manufacturer will create a pill which may look a little different however all of the generic forms of Truvada contain the same active ingredients Tenofivir and Emtricitabine, the medication that protects against HIV infection that makes PrEP work.
If you are receiving your PrEP from your Australian pharmacy or via any of the following online pharmacies you can feel reassured that your PrEP is geunine and effective.
Of course if you have any questions about PrEP be sure to talk to an experienced PrEP doctor in your local area. If you are in Melbourne I am happy to chat.
Dr George Forgan-Smith
267 Collins St, Melbourne VIC 3000
(03) 9654 6088
Dr George Forgan-Smith
PrEP is a tablet when taken daily can reduce the risk of HIV infection by over 99%. To be most effective the it is recommended to take the tablet on a regular basis ie. each day.
Life can be hectic and for some a daily tablet can be tricky. A study at the City University of New York School of Public Health has identified 6 different ways to help ensure you are remembering your daily tablet:
Pill boxes are a great way to help give a visual reminder of whether you have taken your tablet or not.
They also have the advantage of letting you know when you are about to run out of your medications, a second reminder for when you need to return to your doctor for a new script as well as your quarterly sexual health check up.
There are many ways to remind yourself to take your tablet… Some ideas include a sticker on your mirror that reminds you that you need to take a tablet.
One idea that worked for a patient was a post it note on his coffee container that said “Have you taken your pill?” Often it’s the simple things that work the best!
The human mind loves routine… Get up, take your pill, have a shower. This has been my daily routine for years…
The key is to find something that you do on a regular basis and then attach taking your pill to this. Do you always start your day with a coffee? Stick your tablets next to your coffee cup so you will always be reminded of your PrEP when you prepare your coffee.
If you take your medicine before you sleep, put the tablets beside your bed with a glass of water to remind you. Find that one thing you do on a regular basis!
Almost all phones now have alarms and reminder systems you can set to go off on a daily basis.
One simple idea is to set an alarm that goes off each morning say 30 min after you have woken up. Call it “take your pill” and you have your daily reminder.
Of course there are many apps you can download onto your phone to remind you to take your tablets. Check them out but I find the simple solutions are the ones that work the best.
Life can be hectic. Sometimes we leave the house quickly and can forget out tablets. I have a small metal pill container that has a couple of my PrEP tablets inside it. I’ve thrown this into my work bag so I have a spare if I ever need it. I found this on on Amazon that works great for me -> Waterproof Pill Container
TIP: make sure you get a water proof one just in cast it gets thrown into the washing machine.
If you have a close friend who also takes PrEP, set up a daily check in where you call or text to remind each other to take your medications…
This simple system can help ensure you both are taking your meds as well as a great chance to keep in touch!
As you can see there are many ways to ensure you are able to take your tablet each day. Remember that when taken daily PrEP is highly effective in reducing the risk of HIV infection. It’s normal to miss one or two tablets, I hope these ideas reduce this occurrence helping you stay healthy and in control of your health.
What’s your favourite way to ensure you get your daily pill? Leave a comment below.
หากคุณมีความเสี่ยงต่อการติดเชื้อเอชไอวี PEP เป็นยาที่สามารถหยุดการติดเชื้อเอชไอวีได้
สิ่งที่สำคัญที่สุดคือการใช้ PEP ภายใน 72 ชั่วโมงหลังจากเสี่ยงต่อการติดื้อเช เอชไอวี
ตั้งแต่วันอังคารถึงวันศุกร์ดร. “GEORGE FORGAN-SMITH” สามารถช่วยคุณทดสอบและใช้ยาหากคุณมีความเสี่ยงต่อการติดเชื้อ
หากคุณต้องการพบฉันที่ Collins Street Medical Center เป็นสิ่งสำคัญที่จะบอกคนที่แผนกต้อนรับว่านี่คือการนัดหมาย PEP ด่วน เราสามารถทำการทดสอบทั้งหมดและเริ่มการรักษาเพื่อป้องกันเอชไอวี
คุณสามารถทำการนัดหมายทางโทรศัพท์ + 61 3 9654 6088
您可以通過電話預約 +61 3 9654 6088
Huge kudos to the team at Prepster.info – a PrEP advocacy group in the UK who worked with The Terrence Higgins Trust to test the quality of multiple generic PrEP tablets sold by six online generic PrEP pharmacies.
What were the outcomes? I’ll let the team at Prepster tell you:
Fourteen different bottles of PrEP from online suppliers were tested. In addition, Truvada and PrEP from the England IMPACT Trial was also tested. The results showed that there’s no evidence of fake PrEP in any of the samples we obtained across the summer of 2018 from any of the six suppliers.
Generic PrEP is just as safe as Truvada brand when purchasing from the tested overseas pharmacies. It’s not just safe, it’s exactly the same as the known Truvada brand.
If you would like to learn how to import PrEP legally into Australia be sure to review my post here: How To Import PrEP For HIV Prevention Into Australia.
Please remember to legally import PrEP into Australia:
If you are based in Melbourne I am more than happy to help facilitate your access to PrEP for HIV prevention.
Regards, Dr George Forgan-Smith
If you have had a potential exposure to HIV, PEP or Post Exposure Prophylaxis, a medical treatment to prevent HIV infection is available with Dr George Forgan-Smith at Collins Street Medical Centre.
If you have had a HIV exposure PEP or Post Exposure Prophylaxis can help prevent HIV infection. Common ways to be exposed to HIV include:
If you are worried or concerned it is important to seek medical help fast. PEP is most effective within 24 hours of exposure but can be given up to 72 hours afterwards to work.
Dr George Forgan-Smith is trained in PEP and HIV prevention and can organise all treatment and testing required to start the HIV prevention treatment.
Dr George’s office is at Collins Street Medical Centre 267 Collins Street.
To book an appointment simply call Collins Street Medical Centre on 03 9654 6088 and advise you require an urgent appointment with Dr Forgan-Smith for PEP.
If I am unavailable or it is outside of office hours PEP can be obtained at all the major hospitals and emergency departments.
Hospitals close to Collins Street Medical Centre include:
Further information on PEP is available at Get PEP https://getpep.info
If you are outside of Melbourne there is a full listing of finding places to get PEP Australia wide is here https://www.getpep.info/get-pep-now/
Hey guys. It’s Dr. George Forgan-Smith here. And today I wanted to be able to share with you that PEP is now gonna be available from the Collins Street Clinic. I’ve been able to talk with the health department and I’m able to offer full post-exposure prophylaxis here at Collins Street Medical as part of my ongoing work in HIV and HIV prevention.
So PEP is a treatment that is offered after a potential exposure to HIV. For example, condomless anal sex. Whether that be as a top or as a bottom, it is still a potential risk of HIV infection. So the trick with PEP is that we need to get the treatment started ASAP. So within 72 hours of your potential exposure. So please, if you feel that you need PEP, please let the front desk know that you need an urgent appointment to see myself. If I am unavailable or it’s a weekend, then I do recommend heading straight to Melbourne Sexual Health. Or outside of hours you can go to any of the bigger hospitals with high HIV loads. For example, The Alfred, St. Vincent’s, Royal Melbourne, these are all hospitals that are able to help with PEP as well. However, if you come in and see me, I’m able to organise all of the screening testing as well as a prescription for the medication that you will need to take. Of course, this is something that we’ll converse about and we’ll talk about your potential exposure and the risks and the best way to move forward.
So if you’ve had a potential exposure to HIV that you’re worried about, please book in to see myself or a sexual health clinic as soon as you can and we can ensure that you are heading in the right direction to get on PEP, post-exposure prophylaxis for HIV.
Wow! What a weekend… I’ve been locked away working on helping ensure that PrEP is an international language!
The PrEP consent video is now updated to meet the current 2018 guidelines but more exciting is that they have been translated into 26 different languages including captions on the video! Check it out 🙂
Now while I wish I spoke all these languages, I have had to start with using machine translations, so I ask if you seen anything funky could you please send me an email and let me know?
Translations so far:
If I have missed your language or one you feel should be included, again please keep me in the loop!
Here’s to fantastic health, no matter what language we speak!
PrEP Appointment Transcript
PrEP is a medication that is used to help reduce the risk of HIV infection. When taken as instructed, it can reduce the risk of HIV significantly, by up to 99%. So it’s important that you have a full understanding of what PrEP is and how it works. In you’re first appointment with a doctor about PrEP, you should have the opportunity to be able to talk about all of the potential side-effects of PrEP, how to take it, how to fill your PrEP prescription or to import it if you wish to do it that way, but also to have all of your questions answered in a way that helps you feel confident and able to move forward understanding what is going to be happening. It’s also a good chance to be able to discuss strategies to help you take the tablet on a regular basis and to also talk about what can happen when you first start taking PrEP.
When you have a good understanding of the risks, the side-effects, the benefits, and how to take it, if you are still happy to go ahead, then your doctor will be able to provide a prescription for PrEP. It’s important that you get specific testing done as well. So for PrEP, you do need to have a full sexual health screening, and this is to ensure firstly that you’re HIV negative before starting PrEP. But it’s a great chance to also check that all the rest of your sexual health is in great condition. It’s also important to do a check of kidney function. PrEP can affect kidneys in some people, so it’s important that we keep a close monitoring of your kidney function.
Finally, it’s great chance to be able to talk with your doctor about the follow-up, and that is every three months you do need to come back for kidney function testing, HIV testing, and sexual health screening as well. At this point, you’ll be able to get your next prescription for PrEP. So it is a regular routine at every three months you do need to come back. The subsequent appointments can be a little bit shorter and can usually be done in a 15-minute appointment because once you have an understanding of PrEP, we don’t need to go through the consent every single time. However, if you have questions or if you have side-effects, it’s important you bring them up with your doctor so you can talk about it.
This is what I wanted to basically teach you guys as to what to expect in a PrEP appointment. If you do see a doctor and they’re unsure about PrEP but willing to learn, there are many resources that can help them. However, if you experience a doctor that may not be fully aware of what to do, there are many doctors who are happy to help. Pen or PrEP access now has got a fantastic map that shows doctors who are willing, ready, and keen to prescribe PrEP, and I will put a link to that map here with the video as well. So I hope this is helpful and given you a bit of an idea about what to expect in a PrEP appointment when you go to see your doctor. I hope that was helpful. Have a great day. See you guys.
Hey guys. It’s Dr. George here, and I’ve had a few inquiry from patients as well as people mentioning online, so I thought I’d make a quick video just to explain and answer these questions.
PrEP now that it’s available on the PBS. There have been some concerns about a change in the colour and the shape of the tablet.
So, there are three different versions of PrEP that are available under the PBS here in Australia.
There’s the Truvada brand, but the most common one I’m seeing is the Mylan brand. What’s actually happened is that the Mylan that is available under the PBS is a slightly different colour. It’s a more greenish-blue colour, and the pill shape is just a little bit different. However, what I want to reassure you is that just because it’s a generic medicine, just because it’s changed shape, it still contains the exact same active ingredients, the tenofovir and the emtricitabine, it’s just a slightly different shape. Think about the difference between say Panadol brand and, I don’t know, Herron Paracetamol. They’re both exactly the same medicines, it’s just that they’re in a slightly different presentation.
But with all generic medicines, they still contain the same active ingredient, the same effect taking a generic form of the Truvada will still give you the same protection against HIV when taken as instructed by your doctor.
So don’t be disturbed if the version of PrEP that you receive is in a slightly different bottle, slightly different shape, slightly different colour. As long as you’re getting it from your pharmacy and the same supply chain, you will still have the exact same protection and medication you have been taking in the past, whether that be part of a trial or whether that be from importation from overseas. PrEP will work and all of the medicines being sold under the PBS have been very carefully vetted.
I hope that helps clarify any questions that people may have. Happy to answer questions if you place them in the comments below.
Just received the question about whether PrEP protocols are going to change now that PrEP medications are covered under the Australian PBS?
To answer the question, no. All people on PrEP will still need regular STI screening and health checks every 3 months.
It’s important to get a quarterly appointment with your doctor for a new script and the following recommended testing:
I hope this helps clear up any questions.
Dr George Forgan-Smith
Intermittent PrEP also called “PrEP on demand” is a way to take PrEP medication if you find your level of sexual activity is infrequent, your risk of exposure is only for short periods of time – such as travel, or you have significant side effects from PrEP that make taking daily tablets undesirable. (1)
The iPerGay study showed that short term use of Truvada PrEP can be effective using the following schedule (2) for CIS males who have sex with other men:
The following video helps explain how to take intermittent PrEP using 3 different examples
Take 2 tablets of Truvada 2-24 before sex, then take one tablet every 24h after the first dose till you’ve had 2 days (48h) free from sexual activity.
If you have finished your episode of PrEP and then potential sex come up how do you proceed?
From this point it’s continue as above, one tablet of PrEP every 24 hours till 48 hours has passed free of sex.
Currently on demand PrEP research has looked at gay males only. (3) The Australian PrEP Guidelines note:
It is important to emphasise that on-demand PrEP should not be used in cis-gender women, heterosexual men or trans individuals owing to a lack of data about its efficacy in these populations.
So, intermittent dosing is per episode taking of PrEP, so you really only take the PrEP during a period where you are having sexual intercourse that could lead to a potential transmission of HIV.
So, I wanted to explain the process. It’s quite straightforward, basically you start by taking two tables of PrEP, two to twenty-four hours before you think you’re going to be having sexual activity. Then, if you do have sexual activity you take a single tablet of PrEP every 24 hours until there has been 48 hours of intercourse free time.
Say for example you’ve heard from a friend and you’re looking forward to catching up i think them on Saturday. Let’s have a look at a calendar and see how this would work. So, Saturday morning you hear from your friend, it’s about two to twenty-four hours before you’re going to catch up with your friend, so you would take your two tablets of PrEP, say Saturday morning.
Then, Saturday evening you catch up with your friend and you have sexual intercourse. You then take one tablet of Truvada, 24 hours after you took these first two tablets, and then you have a second tablet of Truvada, again 24 hours after this tablet. So you’ve had two tablets, and then the next tablet 24 hours later, and another tablet 24 hours later.
So if you’ve only had the sex on the Saturday, you would stop taking the PrEP on the Monday. If you had sex on Saturday, and on Sunday, then you would need to take an additional tablet of PrEP, because we want to make sure that we have 48 hours free from sexual activity.
Say for example you took your two tablets and had sex on the Saturday, then you didn’t have sex on the Sunday, but you did have sex on the Monday. Again, you need the 48 hours of sexual activity free, and that’s a single tablet of PrEP every 24 hours. Sex on Saturday, no sex on Sunday, but you did have sex on the Monday, then you just need to make sure that you take a tablet of PrEP on the Tuesday and a tablet of PrEP on the Wednesday.
Of course, be sure to talk with your doctor about whether intermittent dosing is for you. It is generally good for most people, the only people who should not be on intermittent dosing are people who are living with hepatitis B infection, because going on and off of the Tenofovir and Emtricitabine can effect the hepatitis B virus. If you would like to learn more about intermittent dosing and prep, be sure to talk with your doctor to make sure you have a full understanding on how it works. I hope this was helpful.
Hey, guys. It’s Dr. George here. Today I’ve been asked the question: What is the difference between treatment as prevention and PrEP? These are two important concepts when it comes to HIV, but also HIV prevention. It is important that people are aware of the differences between the two.
PrEP is pre-exposure prophylaxis, a single tablet taken every day that reduces the risk of HIV infection in a person who is HIV negative, somebody who is not living with HIV. What it does is it blocks HIV from being able to take hold in the body.
It is very different to treatment as prevention, or TasP. What TasP is is when a person is living with HIV. Successful treatment over HIV is the use of medications to bring the replication of the HIV virus in the body down to a point where it can no longer be detected in the blood. That’s called a non-detectable viral load. And, as we know, a person with a non-detectable viral load is not able to transmit HIV full stop. Treatment as prevention is allowing people to get onto HIV treatment that greatly improves their own health benefits but also the health benefits of their partners by blocking the transmission of HIV as well.
You may have seen a previous video that I did which was about U=U, or undetectable viral load is untransmittable. That’s what TasP is about. I hope this is helpful and helps clarify the difference between PrEP, or a tablet taken every day to block HIV from being able to take hold in the body of somebody who’s negative, versus TasP, or treatment as prevention, which is a medical intervention for people living with HIV that stops the replication of HIV to a point where it can not be detected in the blood. What this means is great health benefits for the person living with HIV and their sexual partners because HIV cannot be transmitted.
That’s the difference between TasP and PrEP. I hope that was helpful. If you have any questions, please by all means send me a message and I’ll make sure I get an answer for you. Have a great day, guys
Reinforcing the message that U = U
When HIV is Undetectable, then it’s Untransmittable. Zero risk, and that’s a fact.
While the evidence has been out for a long time we know that successful treatment with HIV medications not only has huge health benefits for the person living with HIV, we also know that it makes HIV impossible to be passed on.
Other advances include PrEP, a single daily tablet that reduces the risk of HIV infection by more than 99%.
The combination of U = U and PrEP is our keys to stopping HIV in it’s tracks. As noted by ACON’s Gavin Predergast, with treatment as PrEP “HIV has nowhere to go now.”
As part of the campaign executive director and cofounder of Prevention Access Campaign (PAC), Bruce Richman will be speaking across Australia to help share the message of U = U
Full details of the tour available here: Bruce Richman U=U Speaking Tour
If you would like to learn more about PrEP, HIV or sexual health be sure to talk with your local HIV prescriber & sexual health specialists.
Dr George Forgan-Smith
In this video I wanted to explain the best way to take PrEP when travelling, in particular when you are crossing time zones.
As noted in previous videos, Truvada for PrEP is a robust treatment and occasional changes in time of dosing will not have a major impact on it’s protection against HIV.
I recommend all people continue to take the medication at the same time they would normally take the medication.
When changing time zones the trick is:
If I am flying to the USA from Australia, I take my PrEP in the morning before I head to the airport.
My flight is usually around lunch and then it’s a 14h flight to the USA.
Normally I arrive at the morning in the USA when I would normally take my PrEP. On this day as it’s been more than 12h since the tablet (acuatlly pretty close to 20 hours), I just take the PrEP and continue to take it at the same time each day.
I hope this has helped explain this process.
Also of note, when travelling be sure to carry your medications in the bottle it was supplied with your name and drug information on the sticker.
I like to carry a letter from my doctor as well explaining why I am taking the drug.
Remember some countries have laws around people living with infections such as HIV so it can be helpful to have this letter to explain whey you are taking PrEP.
Of course if you have any questions, be sure to talk with your doctor before heading over seas.
Dr George Forgan-Smith
In this video I just wanted to share how to quickly check for any interactions between PrEP and prescription medications you may be taking.
While Truvada (Tenofovir & Emtricitabine) are a well tolerated medication there are a few drugs that can interact. In particular, medications that can affect the kidneys are always worth checking with your doctor.
The site I recommend to check for drug interactions is the University of Liverpools site:
For users of PrEP you can either choose to use the trade name – Truvada, or it’s individual medications – Emtricitabine & Tenofovir-DF. Once checked off you can then go to the second column where you check the other medications you wish to check. Don’t forget there are generic versions of Truvada such as Tenvir-EM and Ricovir-EM, both are commonly used in Australia for those who import PrEP.
Of course remember that we are all individuals and we can all have unique responses to different medications. For this reason it’s important to discuss all new medications with your doctor, even ones over the counter.
There can be serious drug interactions between some HIV medications with party drugs so again, talk with your doctor to help avoid harm.
Dr George Forgan-Smith
Hey, guys. It’s Dr. George here. I’ve just been part of a thread on Facebook where we were talking about the storage of Truvada, the drug that’s used for HIV treatment, but also for HIV prevention. I just wanted to share some tips when it comes to the best way to store your medications.
Now the manufacturers, Gilead, have recommended that the drug be stored in a temperature-controlled environment, preferably around about 25 degrees centigrade, or between 15 degrees centigrade and 30 degrees centigrade. The reason for that is that the extremes of temperature could lead to degradation of the drug within the tablet and they’re not able to guarantee its safety. It’s best don’t store it in the car, don’t store it in the fridge. You can leave it on the table. Assuming that your room is of those temperatures, then it should be all okay.
Another thing that I did want to share, though, is when you have your bottle of Truvada, inside the bottle is one of these little fellas. It’s a little plastic container that’s filled with silica.
The reason is there is to absorb moisture that’s in the air. Because in a very humid environment, air with lots of moisture in it, the tablets can actually degrade. This of course can lead to issues with the medication. We’re not 100% sure it can be effective if the tablet’s all mushy and yucky. You may not get all of the full dose of the tablet or the medicines. It is very, very important that, one, don’t store the medicine in a humid environment such as in the bathroom, because that steamy air could lead to the tablets breaking down. The other thing is keep that little silica thing inside the jar. When you’re closing the jar, make sure it’s really nice and tight. That will prevent the moist air getting into the jar, and then you’ve got the little silica thing inside to absorb the moisture so your tablets will stay intact.
That’s pretty much for all medicines. If there’s a little silica thing inside there, keep it inside the bottle. I know it’s frickin’ annoying to get the tablets out past that thing, but it’s there for a reason, so keep it inside the bottle.
Main points are, try and keep your medicines in a dry, warm environment, somewhere between 15 and 30 degrees. They’re great tips and it’s a good idea. Don’t store your medicines in your car. Don’t store your medicines in the fridge. Keep them in an environment where it’s a bit more temperature and weather-controlled. That way you can be sure that there’s no potential damage to your medications. I wish you the best and I hope that was helpful.
Have a great one. See you guys.
Just wanted to say a special thanks to Mu Delta for kindly agreeing to share his experience of PrEP not only from a user perspective but also for someone in Europe. PrEP is now starting to increase in use in Belgium.
If you would like to learn more about PrEP be sure to enjoy the other videos of this website.
Reported at Avert.org, PrEP has now included in the World Health Organization’s (WHO) essential medicines list.
Earlier this month, the World Health Organization (WHO) updated their list of medicines deemed ‘essential’ as part of a well-functioning health system. That is, the drugs that every person should have access to, should they need it, no matter where they are.
Notable was the inclusion of pre-exposure prophylaxis (PrEP), taken as either tenofovir monotherapy, or in combination with emtricitabine or lamivudine, to prevent HIV infection. The addition supports current WHO guidelines for HIV prevention, treatment and care released at the end of 2015, which recommend PrEP for HIV-negative people who are at-risk of HIV infection. These include populations who are unable to negotiate condom use, those in a relationship with someone living with HIV, and people who do not use condoms.
Recognition by this world body stands tall in acknowledging the important role PrEP plays in breaking the transmission of HIV world wide.
Also notable is the inclusion of HIV treatment dolutegravir, a potent agent with a strong barrier to the HIV developing resistance.
Here in Australia I hope this news may help bolster the application for PrEP to be included as a government funded medication.
Currently PrEP users not part of one of the Australian trials must import generic PrEP from overseas. Simplifying access and reduced cost for PrEP will be a great step towards reducing HIV infections Australia wide.
One of the more common questions for people who are going on to PrEP is, does this mean that I can stop using condoms? We know that condoms have a role in all sexual health, not just HIV prevention. Taking PrEP every day does greatly reduce the risk of HIV infection. Adding condoms into the mix can also help reduce the chance of transmission of some STIs. However, it is important to know that we understand that people are going on to PrEP because the condom is not always used when it comes to sexual encounters. However, we can encourage that as part of a full comprehensive sexual health protection that condoms can be a useful part of this.
PrEP does have some rare side effects that are very important to follow through with. The first one is that in some people, PrEP can reduce the function of the kidney. For this reason it’s very, very important that when you’re starting PrEP, that you have a very careful examination of the patient’s medical history. Are they diabetic? Do they already have preexisting kidney disease? Are they on medicines that can affect renal function such as metformin or frequent doses of NSAIDs that could reduce the function of the kidney?
We also test kidney function. If you have a patient whose eGFR is less than 60, it is important to talk with a HIV specialist before initiating PrEP. We do know that occasionally, there can be a slight reduction in eGFR in our patients. We do know that when stopped the PrEP, the eGFR does tend to return back to normal. However, if you notice any concerns, worries or changes in kidney function, it’s important to have a talk with a competent, confident, PrEP prescriber or HIV specialist to discuss options and the best way to deal with these particular issues for your patients.
What are the contraindications of going onto PrEP? The number contraindication to go onto PrEP is that the person is already infected with HIV. For this reason, it’s very important at the beginning of the screening process that we do a test for HIV. We’re looking for HIV-1 antibodies, HIV-2 antibodies, and if we can use a fourth generation that checks for p24, this greatly reduces the window period. If somebody has had a potentially high risk exposure to HIV a month before they’re considering starting PrEP, it’s worthwhile to carefully monitor their status to make sure that the person has not had an exposure and infection with HIV beforehand. If the potential risk and exposure to HIV is within 72 hours, it’s worthwhile talking with this patient about going PEP or post-exposure prophylaxis.
It’s important to have a review of people’s medications before they start PrEP. Any medicines that could affect renal function are worthwhile making sure that everything is okay. Examples include people who are on ACE-inhibitors, people who are on metformin, or who regularly use [inaudible 00:00:20], all of these drugs can affect kidney function so it’s important that you review these medicines as well as making sure that their kidney function is okay. These are not contraindications to starting PrEP. However, it is good to know where you are starting from and if you are going to be adding any of these medications whilst the person is being treated on PrEP. It’s worthwhile to carefully monitor renal status during this process.
For this reason, I like to make sure that I have all of the information for my patients. Sometimes patients may only come to you for PrEP but they may have another GP. It’s important to be able to talk with your patients about the importance of continuity of care and all doctors having access to this information, not just for yourself, but also for the other practitioner as well. I understand that there are some patients who are worried about confidentiality in situations like this. However, their health is vital so it’s important that you reinforce to these patients that somebody or both doctors have to be in complete communication to make sure that everybody is aware of all medicines that are being taken.
If you have a patient who there may be a risk that they have been exposed to HIV one month before initiating PrEP, I like to organise a second appointment to confirm HIV status before the person starts taking the medications. My normal flow would be that I organise the full screening tests, and if the patient is importing medications, what I do is I bring them back when their medicines have arrived. This is a chance to discuss how to take PrEP, but also to do a second HIV test to confirm that they are HIV-negative.
Follow-up appointments for PrEP are fairly straightforward and can be done in a systematic way in a 15-minute appointment. The first thing I like to do is have a conversation with the patients about how everything is going. Have they had any issues with the medications? In particular, are they having any side effects, and particularly, are there any side effects that’s stopping them from being able to take the medicine?
Gut side effects are quite common and for this reason, I do recommend that they trial taking the medicine either with food or at slightly different times. People who get nausea after taking the tablet, I sometimes say, “Why don’t you try taking it at night before you go to sleep?” That way, if the nausea comes, they may be asleep while it’s happening and they may miss out on that particular side effect. What we know is that this particular side effects does tend to wane quite quickly.
Very occasionally, I have had some patients who have developed unusual rashes while taking PrEP. I’m not 100% sure of these mechanisms, but it does seem to happen infrequently. Again, this seems to be a minor side effect that does go away. However, remember, when a person is seroconverting, round about 70% of people during the seroconversion to HIV-positive can get a rash. This is a very important point in time to do a full sexual health screening and to check their HIV status. I would do that as a part of a fourth generation antibody test and include P24 as well.
The screening tests that I like to organise before starting PrEP include: I like to check kidney function. We need to know that the kidneys are working well and that they have an estimated glomerular filtration rate of more than 60. This is also a good opportunity to review a full sexual health screening. This includes a throat swab for chlamydia and gonorrhoea, a rectal swab for chlamydia and gonorrhoea, a urine test for chlamydia and gonorrhoea, and a blood test to check for HIV, syphilis, and it’s a great chance to check hepatitis A, B, and C status. In addition, as mentioned before, it’s important to check the renal status, perhaps a full blood count, have a look at phosphate, and if somebody is at potential risk of osteoporosis it might be worthwhile considering vitamin D status as well. If you have a patient with established osteoporosis or who is at high risk of osteoporosis, it may be worth considering getting a baseline bone density scan before starting PrEP.
If a person misses an occasional tablet of PrEP, it’s not a huge impact on the efficacy of the drug. The most important thing is that we want to reinforce that people take the tablet every day. An occasional missed tablet is not going to greatly reduce the protection against HIV. The protection against HIV infection drops off significantly, when people are taking less than four tablets a week. In patients who are struggling to take the tablet on a regular basis, it’s great to be able to have some time to brainstorm ways to help ensure that this person can get into a routine of taking their tablet every day.
If somebody misses a tablet, they don’t need to double up the next day. Also, some patients are worried that if they have a particularly highly active period of sex, that they should double up on their medicines. This is not the case. A single tablet every day is the effective dose. There is no need to increase the amount of medicine taken, if there is an increase in sexual activity.