HIV Prevention Medication

HIV PrEP / PEP drugs can reduce transmissions by 80-90%.

I am concerned about HIV. What can I do?

The mainstay of HIV prevention can be remembered as A B C D:

A

Abstain from high-risk sexual behaviour

B

Be Faithful

C

Use a condom. Both males and females have the right to carry one and request their partners to put it on.

D

Drugs, when taken properly can prevent HIV transmission by 80-90%.

Who should consider taking HIV prevention drugs?

  • Males with different partners (male and females)
  • Males who frequently have sex with males
  • People who travel overseas and have sexual activities

Who should consider taking HIV prevention drugs?

  • Males with different partners (male and females)
  • Males who frequently have sex with males
  • People who travel overseas and have sexual activities

How effective are the HIV Prevention drugs?

  • The drugs only work if they are taken.
  • There are two regiments taken to prevent HIV.
  • Daily regiment where 1 tablet is taken 7 days before the sexual encounter and throughout 1 tablet daily during the sexual encounter and 1 tablet daily for 1 month after the sexual encounter.
  • If this regiment strictly adhered to, we are looking at 90% prevention.
  • Very effective for men who have sex with men:
    In a study, taking the drug 2 -24 hours prior to sexual encounter, followed by 1 pill daily during the sexual encounter and 1 pill daily for 2 days after the sexual encounter. For example, if person A decided to have sex tonight, he takes 2 pills 2 hours prior. He then takes 1 pill the next day and 1 pill the day after. Total pills taken is 4. Person B is going on a trip for 5 days. He is concerned that he might be sexually active in those days. A regiment he would consider is 2 pills on the first day, 1 pill daily from day 2 to 5. 1 pill daily for 6th and 7th day. Total pills taken is 8. Following this regiment, HIV is prevented 80% of the time.
  • What about men who have sex with women?
    More research is needed. However, based on the drug levels, it should work Since the drug works by prevention of viral replication in the cells, there is reason to think that it will be effective. Moreover, penetrative vaginal sex has a lower risk of HIV than penetrative anal sex. There are NO CURRENT recommendations for medications and dosing for this, but there is good reason to think that the regiment above should work.

How effective are medicines to prevent HIV?

Medications are effective.

It is difficult to do studies in humans with regards to efficacy. However we can extrapolate from 2 sources of data.

For a single drug, the risk of HIV is cut down by 67% of transmission of mother to children via childbirth.

For healthcare professionals the exposed to needle sticks injury of HIV patients, taking a single drug reduced the transmission by 80%.

These are studies in 1990s with OLDER HIV medications and preventive regiments.

The modern medicines based on animal studies might be more effective. In an animal studies prevention of HIV when the modern medicines are administered within 36 hours appears to be 100%.

How can I get the medicines?

1. First we need to test you for HIV and hepatitis B. The medicines work only if you do not have HIV.

2. We need to test for Hepatitis B because the medicines also treat hepatitis B. This can complicate the treatment of hepatitis B if you do not know if you have hepatitis B and treat it inadvertently.

3. We would also need to test for your blood counts, liver and kidney function at the time of starting treatment and 2 weeks and 4 weeks after.

4. Finally you will need to take the tablets once a day for 30 days.

Who should consider taking HIV prevention drugs?

  • The drugs work by preventing viral replication of the HIV.
  • The drugs ONLY work if the concentrations in the cells are high enough.
  • If you are a male, the MINIMUM time before the sexual encounter is 2 hours. Most guidelines would recommend 7 days.
  • If you are a female, the MINIMUM advised time before the sexual encounter is 1 week. Vaginal concentrations take longer to achieve. Most guidelines would recommend 21 days.

Who should consider taking HIV prevention drugs?

  • The drugs work by preventing viral replication of the HIV.
  • The drugs ONLY work if the concentrations in the cells are high enough.
  • If you are a male, the MINIMUM time before the sexual encounter is 2 hours. Most guidelines would recommend 7 days.
  • If you are a female, the MINIMUM advised time before the sexual encounter is 1 week. Vaginal concentrations take longer to achieve. Most guidelines would recommend 21 days.

I might have been exposed to HIV. What Can I do?

Post exposure medications to prevent HIV.

Are there any side effects?

All medicines have risk of allergy, nausea and vomiting.

We use the latest drug regiment. This is taken once a day and have minimal side effects. Most patients tolerate it well.

What should I do if I want to take HIV preventive medications?

Come in for a consult! Our friendly doctors are will guide you through the process. We will also need to test your HIV status as well as your kidney function. Please call ahead as we will need to arrange for the medications and logistics.

What is the estimated cost to start?

1. Medicines SGD $1800.00
2. Baseline blood test (Hepatitis B, blood counts, liver function, kidney function)
SGD $100.
3. Instant HIV testing $70
4. Consultation $50
Estimated total: $2000.00
Week 2 and week 4 blood tests
Week 2 – $103 SGD
Week 4 – $123 SGD

*All prices are subjected to GST

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