🥳Your healthcare espresso shot is back, this time with a topic that directly concerns certain population groups, but is well worth knowing about for a much broader audience.
🟪Vol. 13: Pre-Exposure Prophylaxis for HIV (PrEP) – The basics
🦠HIV (Human Immunodeficiency Virus) remains a significant public health issue, with more than one million new cases annually worldwide. It affects the immune system and, without treatment, leads to AIDS (Acquired Immunodeficiency Syndrome). With modern antiretroviral therapy, life expectancy of people living with HIV can reach that of healthy individuals.
🩸🫂🤱HIV is transmitted through blood (e.g., sharing needles, razors, or through occupational healthcare exposures), through sexual secretions (e.g., unprotected sexual intercourse), and vertically from mother to child (e.g., during delivery or through breast milk). It is not transmitted through everyday contact.
✅PrEP is indicated for HIV-negative individuals at high risk:
👬Men who have sex with men and engage in high-risk sexual behaviors for viral transmission (e.g., multiple partners, absence of protection)
🏳️🌈Transgender individuals with high-risk sexual practices for viral transmission
👫Heterosexual couples in which one partner is HIV-positive or has a consistently high risk of exposure to the virus
🎥💲Sex workers
💉Intravenous drug users
🧐🤔Other population groups that may benefit include:
🧫Heterosexual individuals diagnosed in the past year with another sexually transmitted infection (STI)
⚠️Heterosexual individuals who have sexual contact with sex workers, intravenous drug users or bisexual males
💊🌡️Oral and injectable PrEP are available. The most commonly used regimen is one tablet daily by mouth, which is also available in Greece. An alternative option is on-demand PrEP, taken for a short period before and after sexual intercourse. For men who have sex with men, on-demand PrEP has equivalent efficacy. Regarding other categories, sufficient data are lacking. Overall, the efficacy of PrEP reaches >99% with correct adherence. PrEP does not protect against other STIs.
💎For PrEP initiation and patient follow-up, individuals are advised to seek physicians with experience and certification in the field.
🔎ℹ️Pretreatment evaluation includes: a negative HIV test, thorough screening for other STIs, baseline biochemical workup, assessment of comorbidities (e.g., osteoporosis), and evaluation for contraindications.
🧑⚕️🩺🔁During PrEP administration, follow-up is required at one month after initiation and thereafter every three months, with the primary objectives being repeat HIV and certain STI testing, adherence monitoring, and surveillance for potential adverse effects (e.g., gastrointestinal disturbances). Certain parameters may be monitored less frequently (e.g., biochemical profile and renal function every six months, reassessment of sexual practices and continuation of therapy every 12 months).
⏯️🔚PrEP may be discontinued when the risk decreases (e.g., a stable relationship or behavioral change). A negative HIV test is recommended prior to discontinuation. Depending on the individual's profile, continuation of PrEP for 2–7 days after the last potential exposure to the virus is required.
📝These were the key concepts of HIV PrEP — undoubtedly a powerful prevention tool, used in combination with all other protective measures.
📖References
-EODY. Protokollo PrEP available at https://www.eody.gov.gr/images/nosimata/metadotika/protokollo-PrEP.pdf
-CDC. Clinical Guidance for PrEP 2026 available at https://www.cdc.gov/hivnexus/hcp/prep/index.html
-WHO. Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach available at https://www.ncbi.nlm.nih.gov/books/NBK572729/