What is pre-exposure prophylaxis (PrEP)?
Pre-exposure prophylaxis, or PrEP, is a way to help HIV-negative people protect themselves from getting HIV. PrEP works by using antiretroviral medication (ARVs) for HIV prevention.
What PrEP products can I get now?
Two types of PrEP, both oral pills, have been approved by a regulatory body for use as prevention. TDF/FTC was the first oral PrEP method available (brand name Truvada), although in select countries generic options such as TDF/3TC and TDF are also available. To date, only TDF/FTC has been approved for all populations. F/TAF, (brand name Descovy) is a newer addition to the prevention portfolio. In 2019, F/TAF was approved by the US FDA for daily use by cisgender men and transwomen. A trial is planned to investigate efficacy in cisgender women.
Someday soon other kinds of PrEP may be available.
A Dapivirine Vaginal Ring may also be available soon. Studies show that the ring, inserted monthly, reduces risk of HIV acquisition through a slow release of an ARV called dapivirine, with no safety concerns. After receiving a positive opinion from the European Medicines Agency (EMA) in July 2020, the ring is on track for WHO pre-qualification and will be submitted for licensure review in key African countries as well as by the US FDA.
Cabotegravir is an ARV currently being studied for use as PrEP. It was found to be safe and efficacious in two studies administering the drug, every two months, as a long acting injection. HPTN 083 enrolled cisgender men who have sex with men and transwomen and HPTN 084 enrolled cisgender women. Both trials will continue as open label extension studies, and the product will also undergo regulatory review.
A dual-prevention pill (DPP), an option which combines active ingredients from oral contraceptives and oral PrEP into one daily pill is also being studied. Results are expected in 2022. This kind of combination prevention is referred to as multipurpose prevention technology (MPT).
Other PrEP strategies in earlier phases of development include a monthly oral pill (islatrivir), a quick-dissolving vaginal film containing ARVs that can be inserted right before sex, and a long-acting implant that could offer protection for up to a year.
PrEP doesn’t protect against other STIs or pregnancy.
Oral PrEP is a terrific HIV prevention tool available now. It doesn’t reduce risk of chlamydia, gonorrhea, syphilis or herpes, and it does not prevent pregnancy. Male and female condoms do. Comprehensive access to PrEP, condoms, voluntary medical male circumcision (VMMC), communication and counseling makes prevention of unwanted sexual health outcomes work for all.