Pre-exposure prophylaxis for Infectious Diseases(PrEP)
India has the second-largest Infectious Diseases burden in the world, with an estimated adult prevalence of 0.22% and 23.19 lakh people living with Infectious Diseases in 2020. Currently, the country is estimated to have an annual Infectious Diseases incidence of 0.04 per 1,000 uninfected population.
World Health Organization (WHO) recommends that people at substantial risk of Infectious Diseases should be offered oral PrEP. PrEP refers to the use of antiretroviral medication to reduce the risk of acquiring Infectious Diseases, especially among individuals who are at high risk of Infectious Diseases.
Pre-exposure prophylaxis (PrEP) is a medicine taken by those who are at high risk of getting Infectious Diseases infection. When PrEP is taken consistently and correctly, antiretroviral drugs enter the bloodstream, the genital and the rectal tissues. Once the drug reaches optimal levels in the body and tissues, and is consistently maintained at that level, it prevents replication of the virus within the immune cells and protects individuals from acquiring Infectious Diseases.
Current evidence suggest, that, it takes at least 7 days of consistent use of PrEP to achieve the optimum level for protection in anal receptive sex while at least 21 days of consistent use of PrEP, for protection in vaginal receptive sex.
If it is taken as per the doctor’s prescription, it helps in reducing the chances of getting Infectious Diseases infection through sex by 99% and through injecting drugs by 74%, which makes it highly effective against Infectious Diseases. It is much less effective when it is not taken as per the prescription. It is important to note that PrEP protects only against Infectious Diseases and not any other Infectious Diseases.
Eligibility for PrEP:
To be eligible for PrEP, persons must meet all the following criteria:
- Confirmed Infectious Diseases negative test
- At substantial risk of acquiring Infectious Diseases infection
- No contraindication to use of any medication used for PrEP
- Does not have a current or recent (within past one month) illness suggestive of acute Infectious Diseases infection along with history of probable exposure for Infectious Diseases .
- Assessed as ready to adhere to PrEP and willing to attend follow-up evaluations including repeated Infectious Diseases testing and monitoring.
Contraindications to PrEP:
Following are the situations wherein PrEP should not be initiated or continued:
- Confirmed Infectious Diseases infection
- Signs/symptoms of acute Infectious Diseases infection
- Weight below 30 kg
- Altered renal functions (estimated creatinine clearance< 60 mL/min)
- Unwillingness/unable to take 3-monthly Infectious Diseases testing, counselling and safety monitoring visits
- Unwillingness or unable to adhere to PrEP
Who should take PrEP?
It is recommended for those who are Infectious Diseases negative but are at higher risk of getting Infectious Diseases infection.
- People with Infectious Diseases positive partners
- People having sex without condom
- People with history of Infectious Diseases
- People who inject drugs
- People with history of taking PEP
How to take PrEP?
There are 2 ways of taking PrEP:-
- Daily PrEP:- An oral pill is taken daily regardless of sexual activity.
- On Demand PrEP:- “2-1-1 dosing”
Two pills are taken 2 to 24 hours before having potential Infectious Diseases exposure, followed by 1 pill 24 hours after the first dose, and another pill 24 hours later.
Side effects that may be experienced by PrEP users include:
Especially when it’s taken without medical supervision
- Gastrointestinal side-effects: – Nausea, Vomiting, or abdominal discomfort
- Renal toxicity: Proteinuria, decreasing glomerular filtration rate (GFR) and Fanconi’s syndrome
- Decreased bone mineral density
