Difference Between Intermittent & Daily PrEP

Dr George talks about PrEP on demand vs daily PrEP


Key points between PrEP on demand and daily PrEP

Daily PrEP

  • Ideal for all people with no contraindications to PrEP (kidney impairment, bone issues or allergic reaction Tenofivir or Emtricitabine)
  • Tablet is taken daily
  • 7 days of tablets recommended before optimal protection
  • Offers 99% reduced risk of HIV transmission per act
  • If you wish to stop you need to take for an additional 7-28 days after your last potential exposure to HIV
  • Regular review with your PrEP provider every 3 months vital

PrEP On Demand

  • Only studied in men and trans women
  • May not be effective for women and trans men. Daily PrEP is the recommended treatment for these groups of people
  • Not suitable for people with active Hepatitis B infection
  • Dosage regime of 2 / 1 / 1
    • 2 tablets of PrEP 2-24 hours before anticipated sexual activity
    • If sex happens, 1 tablet of prep every 24h till 48h has passed since last sexual activity
  • Regular review every 3 months with your PrEP provider is vital

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.