World Aids Day 2019: What is the HIV medicine PrEP and is it available in the UK?

Preventative drug commonly supplied as Truvada not currently offered by NHS England but major trial of 13,000 patients underway

As World Aids Day 2019 takes place, NHS England is facing pressure to begin offering the groundbreaking HIV medicine Pre-Exposure Prophylaxis (PrEP).

Administered as a pill under the brand name Truvada, patients in England can currently only receive PrEP without charge as part of the Impact Trial, which began in September 2017 and aims to test its effectiveness on 13,000 people.

But the preventative treatment was found to cut new transmissions of the virus by 25 per cent in a year in a recent Australian trial, prompting calls from healthcare charities for an immediate national roll-out in the UK when the results of that study were published in The Lancet last year.

What is PrEP?

PrEP sees Truvada given to HIV-negative people before sex to reduce their risk of contracting the infection, the drug combining two antiviral medicines, tenofovir and emtricitabine, long used in HIV treatment.

According to the Terrence Higgins Trust, PrEP has been administered in trials in one of two ways: given on a regular basis (one pill per day) or only when needed. In the latter case, PrEP is administered on the following schedule: two tablets two-to-24 hours before sexual activity, one tablet 24 hours after sex and a further tablet 48 hours after sex. This is known as “on demand” or “event based” dosing.

For people who believe they have had unprotected sex with someone at high risk of carrying HIV, a treatment known as Post-Exposure Prophylaxis (PEP) is available for free from NHS clinics and must be taken within 72 hours of contact to prevent the virus taking hold.

In clinical trials, both approaches have proven to be effective so long as the recipient sticks rigidly to their prescription schedule. Failure to do so might render it ineffective.

One criticism of its testing so far is that studies have been disproportionately skewed towards gay men and that more data is needed concerning its impact on female patients.

The drug is considered safe and side effects are rare. A small minority might experience nausea, headaches and exhaustion, according to the Terrence Higgins Trust.

Users are also reminded that it is not a vaccine and will not protect those engaging in unprotected sex from contracting sexually-transmitted infections, which a condom would help to prevent.

Where can I get PrEP in the UK?

In England, you can apply to take part in NHS England’s Impact Trial via its website.

The health service is currently still assessing whether PrEP meets its strict cost-effectiveness criteria, having tested 7,000 people under the Impact Trial as of June 2018.

It can also be purchased through online pharmacies but prospective buyers are strongly advised to pursue expert advice from sexual health clinics before doing so to ensure you are not being sold counterfeit medicine. The campaign group I Want PrEP Now carries important information on how to find reputable sources.

North of the border, PrEP has been available via NHS Scotland since July 2017. Eligible recipients must be over 16 and have a confirmed HIV negative test from a sexual health clinic.

In Wales, a three-year pilot scheme was commenced that same month via GUM clinics (sexual health centres specialising in genito-urinary medicine, hence the acronym). For more information, see Public Health Wales.

GUM clinics in Northern Ireland are also offering initial consultation and assessment appointments as part of a two-year pilot scheme operating from Belfast. There is no cap on the number of possible participants in either country.

Terrence Higgins advises British patients planning to acquire PrEP online and outside of the NHS to consult with a sexual health clinic before doing so.

Where can I get more information?

For the latest on the situation regarding PrEP and NHS England, you can check out the health service’s commissioning site for updates.

I Want PrEP Now also has a wealth of information on its site.

The Terrence Higgins Trust meanwhile offers personal advice on PrEP via 0808 802 1221.

UPDATE (12.12.19) A previous version of this article referred to dosages of PrEP, and suggested that it could be used administered a regular basis, as well as on an emergency basis. We have amended the piece to make clear that PEP and PrEP are distinct forms of treatment. The former can only be taken within 48 hours of risky sex unprotected sex with someone at high risk of carrying HIV, and for 28 days afterwards.