Welcome To Your Guide For PrEP, PEP, & HIV Prevention

Anybody who at medium to high risk of HIV infection is a good candidate for PrEP. This can include people who are in a serodiscordant relationship, i.e., the person considering going on PrEP is HIV-negative and their partner is HIV-positive. Other people include men who have sex with men, who inconsistently use condoms; people who use methamphetamines or injectable drugs; people who are exchanging sex for commodities, whether that be money, accommodation, food or safety; or, people who are having sex with people who may be in these categories. The most important thing to be aware of is that people need to be aware of the potential risks, side effects and consequences of going onto PrEP. However, if they’re happy, keen and looking for ways to help reduce their risk of HIV infection, PrEP is a fantastic thing to be discussing.

The general flow for my follow-up appointments is that I have a conversation with my patients about any side effects, any issues that they’ve had with taking the PrEP. I do ask about missed tablets because a good opportunity to help reinforce ways that they can be more compliant with taking their medicines. It’s also a really great chance to just see how they’re going.

I ask if they’ve had any diagnosis with sexual infections, because sometimes people will go to other doctors with STIs and have them treated there. If this person has had a sexually transmitted infection, it’s a great time to document this in the chart.

In some people there have been concerns about bone density and the risk of fracture when taking PrEP. This is actually an extremely rare side effect. What we can say is if you have patients with pre-existing bone density issues or they are at high risk of osteopetrosis, it is worthwhile to consider a bone density scan before they start PrEP. Remember there are a number of different ways that we can help optimise bone density in our patients. This includes regular calcium rich foods, weightbearing exercise, regular access to the sun, as well as checking your vitamin D levels and supplementation, if their vitamin D levels are low.

How do you guide people on how to take PrEP? Currently the recommendations in Australia are that PrEP is taken every day. What I’d like to talk to my patients about is to find something that they do on a regular basis and tie taking the medicine to that. Say, for example, if they take another medication in the morning, that’s a great time to take PrEP as well. Or, if they regular do something like brushing their teeth before they head out for the day, make sure that they put the PrEP next to the toothbrush. It’s a great reminder, ah, I’m brushing my teeth. Awesome, I’ll take my PrEP at the same time.
For some people, say, for example, shift workers or people who have a slightly more chaotic lifestyle, what I recommend is that they perhaps get an app in their phone or set a regular alarm that reminds them to take their medicine. Some people tell me that they forget whether or not they took their medicine. In cases like this, I recommend a dosette box where they put out all of their medicines once a week. That way they can be 100% sure they’ve got a visual reminder that tells them whether or not they took their medicine.

If you discover that a person is HIV positive during the screening process of starting PrEP, the most important thing is do not start PrEP. PrEP is not appropriate for this person, this person needs to be on HIV treatment which involves three agents that are active against HIV. Truvada or PrEP only has two agents and it’s important that we offer full, effective, potent treatment for HIV in people who have recently been diagnosed with infection.