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

Some people can be at risk of sexually transmitted infections as is everybody who is sexually active. Every three months it's a perfect opportunity to do a full sexual health screening and 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 hepatitis C. I also check renal function at this time as well.

If a person is living with hepatitis B, PrEP can lead to an increase in hepatitis B viral load when the medicine is ceased. For this reason, if you have a patient who has been infected with hepatitis B, it's worthwhile talking to a HIV specialist or PrEP specialist before initiating PrEP.

After discussion on any particular issues with the tablet, I like to make sure that the person is having any problems in being able to take it every day. This is a really good opportunity to be able to talk about different strategies to improve the ability for a person to take the tablet daily, whether that be setting up dosage boxes, calendars, phone reminders. There are many, many ways to help ensure that our patients are taking the tablet every day.

In an asymptomatic person, a urine test for chlamydia, gonorrhoea, PCR, is best done. They say to have at least two hours since the last episode of urination. We want to get the first part of urine that comes out of the body. If a person has a pustular discharge, it is worthwhile to also do an additional gel swab to be able to do MCS to make sure that there is no resistance, in particular, for gonorrhoea.

How Does PrEP Prevent HIV Infection?

PrEP is a combination of two drugs: Tenofivir and Emtricitabine.

HIV is a virus that is make from a single strand of RNA, the ‘blueprint’ of DNA. To make copies of itself it must first be transformed into DNA where it can then incorporate into the cell’s DNA. From this point it is able to make millions of copies of itself hijacking the cell’s mechanics.

PrEP is only effective against HIV. It does not affect any other sexually transmitted infections. For this reason, it's really important that you reinforce the idea of regular sexual health screening, as well as the use of condoms and their ability to help reduce the transmission of STIs as well.

Other contraindications to go onto PrEP is kidney disease. If a person has an estimated GFR less than 60, PrEP needs to be initiated very carefully. It's worthwhile having a conversation with a HIV or PrEP specialist before starting PrEP.

Welcome to “Is PrEP For Me”: The Doctors' Edition.

In this video series, I want to share as much information as I can about PrEP. Not only about what PrEP is and how it works, but also who it's for, how to prescribe it and how to continue prescribing it. As a caveat, I just want to say that I am based in Melbourne, Australia, and the information that I'm sharing on this website is particular to Australia. There are many great resources for other sections of the world and this information is just as relevant around the world. However, I am focusing in on particular laws and particular ideas that are for Australian doctors. I hope you find this really helpful. If you have any questions, please by all means contact me and I'll do my best to make sure that I get a great answer for you.

I am fascinated at the response, or even that a response was required, by the editor of Attitude Magazine’s article on having a 3 month trial of PrEP.

What concerns me is the almost puritanical responses of people that reinforce slut shaming, “sex is bad” messaging infused with blaming of men choosing to control their own HIV status through medical means.

PrEP has been recently discussed in The Age newspaper after a recent PrEP user seroconverted to HIV positivein Melbourne Australia. Seroconverstion is when  a person becomes infected with HIV, going from HIV seronegative to HIV seropositive.

Hundreds of thousands of people use PrEP worldwide, but there have only been two confirmed cases of infection with a drug-resistant strain of the virus by someone taking the medication properly. A third case was reported in Amsterdam this year, and is still under investigation.