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.
Several African countries where the ring was studied are going through the approval process for the Dapivirine Vaginal Ring, and FDA approval is expected to be decided by early 2022. 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 and WHO pre-qualification in November 2020, the WHO released new clinical recommendations on HIV prevention in March 2021 with detailed guidance for the ring as an additional prevention choice for women at substantial risk of HIV infection as part of a combination prevention package. IPM submitted the ring to the US FDA for regulatory review in early 2021. IPM has applied for the ring to be reviewed by countries in sub-Saharan Africa, where women face persistently high HIV risk. Initial regulatory submissions have been filed for Eswatini, Kenya, Lesotho, Malawi, Rwanda, South Africa, Tanzania, Uganda, Zambia and Zimbabwe. For the latest information, visit IPM's website.
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.