PrEP is an acronym for Pre-Exposure Prophylaxis. It is basically a medicine that you take everyday which reduces your risk of contracting HIV by up to 99%.

It’s like taking a contraceptive pill but instead of preventing pregnancy, it prevents HIV infection.

The key difference is people on the contraceptive pills do not have to use condoms. But people on PrEP are still encouraged to use condoms. This just further reduces the risk of contracting HIV. PrEP is proven to be so effective that it is recommended for anyone who is at significant risk of HIV infection. Hey you can never be too safe right?

Just like the contraceptive pill, PrEP is supposed to be taken everyday. If you miss a dose, it becomes much less effective. But commonly people who are taking PrEP are completely healthy and they really do not like taking a pill everyday. Coupled with the fact that this medicine can be rather expensive, people have been looking for a way to get around the daily pill. Recently, a famous study called the IPERGAY study found that PrEP can be just as effective when taken 2 to 24 hours before the HIV exposure and for another 48 hours later. The problem is this regime can get quite, it gets even more complicated. This can lead to medication dosing errors which unfortunately, happened to this patient that I am going to tell you about.

Mr. L was a successful entrepreneur. He took over his family’s business and has been working hard to make it a success.

His work requires him to travel frequently. On one of his travels, he met Ms. A and fell in love. Ms. A used to abuse IV drugs and because of that, she was infected with HIV. Mr. L knew that if he wanted to be with her, he would have to find a way to protect himself.

It was for this reason that Mr. L came to see me. He read up on PrEP and wanted to find out more. I explained to him all he needed to know then we came to the topic of dosing.

“You should take 1 tablet everyday.” I advised. “This is the recommended regime and it has the best scientific evidence that it works.”

“But I don’t see her everyday. In fact, I only see her less than one time in a month. Must I really take the medicines everyday?” He asked.

“Well, there was a study called the IPERGAY study that says that found that if you take the medicines just for a single event, it can be just as effective. Let me show you a picture (I showed him the picture above in this post). So you have to take 2 tablets, NOT 1 tablet, 2 to 24 hours before the exposure. Then another tablet 24 hours later and another tablet 48 hours later. If you continue to have exposure, you need to continue taking 1 tablet everyday until you complete 48 hours after you last exposure.” I explained. “As you see, this can get rather complicated. You have any questions?”

“No doc, I understand. Yah I think I’ll like to have the meds.” Mr. L replied.

We did the usual blood tests and a rapid HIV test. Mr. L was of course HIV -ve. I explained to him that he had to get these same tests done in 3 months if he is going to stay on PrEP. I prescribed him the medicine and off he went.

The next time I saw Mr. L was 3 months later. He met Ms. A several times and each time he used the medicines.

I took his blood for the usual blood tests and saved a drop for a rapid HIV Combo test. As the test was running, we chatted.

“Any issues with the meds? Side effects?” I asked.

“No. No side effects.” Mr. L replied.

“And you took it correctly right? Before the exposure then 2 days after.” I asked but by then, I could see the positive line appearing on the Combo test. “You test does not look good.” I added.

“What? No, no. I took it after. I think I made a mistake.” Mr. L looked lost as he said this.

To cut a long story short, Mr. L was diagnosed with HIV and is now doing well on Anti-Retroviral treatment.

He ended the relationship with Ms. A and has not seen her since.

Learning points:

– Always make sure you are taking the correct dose of your medicine at the correct time. If you are not sure, get your doctor to write down the instructions. Ask you doctor to explain the dosing again until you fully understand.

For more information on HIV PrEP click HERE


Warning: Invalid argument supplied for foreach() in /home/customer/www/ on line 2678