SERVICEPrEP for HIV

 

What is PrEP, Where to Get PrEP in Bangkok, Who Should Use It, and What Tests Are Required? Essential Information Shared by a Sexual Health Physician

 

Key Points:

• PrEP (Pre-Exposure Prophylaxis) involves taking antiretroviral medication to prevent HIV infection.
• Everyone who is sexually active, whether adults or adolescents, should be informed about PrEP.
• Before starting PrEP, individuals should be tested for HIV, hepatitis, kidney function, and blood lipid levels (for certain PrEP formulations).
• HIV and other sexually transmitted infections (STIs) should be tested every 3–6 months.
• PrEP does not protect against other STIs like syphilis, gonorrhea, chlamydia, etc.

 

What is PrEP, and Who Should Use It?

          PrEP stands for Pre-Exposure Prophylaxis, and it involves using antiretroviral medications known as antiretrovirals. These medications hinder and reduce the replication of HIV, thereby preventing infection.

          PrEP is suitable for individuals who are HIV-negative but at risk of HIV infection through sexual activity or sharing needles for drug use.

 

You might need PrEP if:

1. Your partner is HIV-positive, or you are unsure of their HIV status.
2. You do not use condoms consistently during sex.
3. In the past six months, you have contracted an STI such as gonorrhea, chlamydia, or syphilis.
4. In the past six months, you have used recreational drugs via injection, regardless of whether you shared needles with others.

 

Tests you need before taking PrEP:

1.HIV Test: Ensure you are HIV-negative before starting PrEP.

          Everyone should get tested to confirm they are HIV-negative before starting PrEP. The medications used to treat HIV and those used for HIV prevention are different. Taking PrEP while already infected with HIV can mask symptoms, leading to undetected infection, delayed treatment, and the risk of drug resistance.

 

2.Kidney Function Test: Assess your kidney health.

          Before starting PrEP, everyone should have their kidney function tested to establish a baseline for monitoring during treatment and to choose the right formula for each individual. Different PrEP formulations are suited to patients with varying levels of kidney function.

• F/TDF is suitable for individuals with an eCrCl ≥ 60 mL/min.
• F/TAF is suitable for individuals with an eCrCl ≥ 30 mL/min.

         *Please consult with your physician for more detailed information.

 

3.Hepatitis Test: Check for hepatitis infection.

          If you have never had hepatitis B or have not been vaccinated for it, you should be tested for hepatitis B infection before starting PrEP. Although having hepatitis B is not a contraindication for taking PrEP, some PrEP formulations are also used to treat hepatitis B. However, if a patient is unknowingly infected with hepatitis B and stops taking PrEP, it can cause a rapid rebound of the virus, leading to significant liver damage.

 

4.Lipid Levels: For certain PrEP formulations e.g. F/TAF, you need to check your blood lipid levels before starting PrEP.

 

What tests are needed while taking PrEP, and how often should I take them? 

1. HIV Test: You should see your doctor for an HIV test every 3 months to confirm you remain HIV-negative. If you become HIV positive, PrEP alone is not enough, and it cannot be used as a substitute for an HIV treatment regimen. 
2. Testing for Other STIs: PrEP does not protect against other sexually transmitted infections (STIs) such as syphilis, gonorrhea, or chlamydia. Therefore, you should get tested for STIs every 3–6 months. The method and frequency of testing will be determined by your physician based on your sexual risk behaviors. Testing methods may include blood tests, urine samples, or swabs from the mouth, anus, or vagina. The PCR (Polymerase Chain Reaction) test can detect infections even before symptoms appear, offering quick, sensitive, and specific results. 
3. Kidney Function Tests: Every 3–6 months, your kidney function should be monitored. Your physician may recommend more frequent testing if you have existing conditions like high blood pressure, diabetes, or are taking other medications that affect kidney function (such as NSAIDs). If your kidney function worsens significantly, your physician may advise you to stop taking PrEP.

          Always consult your healthcare provider for detailed information and personalized advice.

 

How effective is PrEP in preventing HIV?

When taken consistently as prescribed by a physician, PrEP can reduce the risk of HIV infection from sexual activity by up to 99% and the risk of HIV infection from intravenous recreational drug use by at least 74%.

 

How to Take PrEP, and How Many Days Do You Need to Take PrEP Until It Can Prevent HIV Infection?

Daily Oral PrEP Regiment
          This method is widely accepted and proven to be highly effective in preventing HIV infection. The current data indicate the following timeframes for PrEP to reach protective levels in the body:
– Receptive anal sex: reach a protective level after 7 days of consistent use.
– Receptive vaginal sex, injection drug use, and oral sex: reach a protective level after 21 days of consistent use.

On-Demand: 2-1-1 PrEP Regimen
          Some PrEP formulations, such as F/TDF, can be taken off-label using the 2-1-1 method for men who have sex with men (MSM):
– Take 2 pills 2–24 hours before sex.
– Take 1 pill 24 hours after the initial 2 pills.
– Take 1 more pill 48 hours after the initial 2 pills.

          However, this method is not officially endorsed by the CDC (Centers for Disease Control and Prevention). Always consult your physician before deciding on a PrEP regimen.

 

Do You Need to Take PrEP Indefinitely? Can you stop PrEP immediately? 

          If you decide to stop taking PrEP, do not stop abruptly. Consult your physician to assess your risk of HIV infection. PrEP levels may remain in your system for 7–10 days after the last dose. If you are still at risk of HIV infection, you should seek alternative prevention methods.

Where Can You Get PrEP in Bangkok?

          In Bangkok, you can get PrEP from the following healthcare facilities:

• Siriraj Hospital
• Chulalongkorn Hospital
• Anonymous Clinic, Thai Red Cross Society AIDS Research Centre
• Ramathibodi Hospital
• Lerdsin Hospital
• Taksin Hospital
• Sirindhorn Hospital
• Max Wellness Clinic

          If you prefer convenience, privacy, and swift service without long queues, you can also receive PrEP and a consultation from sexual health physicians and preventive medicine specialists at Max Wellness Clinic.

Dr. Thanakom Sukcharoen 
Sexual Health Physician and 
Preventive Medicine Specialist

References

https://www.cdc.gov/hivnexus/hcp/prep/?CDC_AAref_Val=https://www.cdc.gov/hiv/clinicians/prevention/prescribe-prep.html

https://sites.google.com/site/prepfaq/doctors-labs/lab-tests

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508611/#:~:text=Polymerase%20chain%20reaction%20is%20a,infection%2C%20followed%20by%20Neisseria%20gonorrhoeae