Welcome To Your Guide For PrEP, PEP, & HIV Prevention

Just wanted to say a special thanks to Mu Delta for kindly agreeing to share his experience of PrEP not only from a user perspective but also for someone in Europe. PrEP is now starting to increase in use in Belgium.

If you would like to learn more about PrEP be sure to enjoy the other videos of this website.

If you have a patient who there may be a risk that they have been exposed to HIV one month before initiating PrEP, I like to organise a second appointment to confirm HIV status before the person starts taking the medications. My normal flow would be that I organise the full screening tests, and if the patient is importing medications, what I do is I bring them back when their medicines have arrived. This is a chance to discuss how to take PrEP, but also to do a second HIV test to confirm that they are HIV-negative.

Follow-up appointments for PrEP are fairly straightforward and can be done in a systematic way in a 15-minute appointment. The first thing I like to do is have a conversation with the patients about how everything is going. Have they had any issues with the medications? In particular, are they having any side effects, and particularly, are there any side effects that’s stopping them from being able to take the medicine?

The screening tests that I like to organise before starting PrEP include: I like to check kidney function. We need to know that the kidneys are working well and that they have an estimated glomerular filtration rate of more than 60. This is also a good opportunity to review a full sexual health screening. This includes a throat swab for chlamydia and gonorrhoea, a rectal swab for chlamydia and gonorrhoea, a urine test for chlamydia and gonorrhoea, and a blood test to check for HIV, syphilis, and it’s a great chance to check hepatitis A, B, and C status. In addition, as mentioned before, it’s important to check the renal status, perhaps a full blood count, have a look at phosphate, and if somebody is at potential risk of osteoporosis it might be worthwhile considering vitamin D status as well. If you have a patient with established osteoporosis or who is at high risk of osteoporosis, it may be worth considering getting a baseline bone density scan before starting PrEP.

If a person misses an occasional tablet of PrEP, it’s not a huge impact on the efficacy of the drug. The most important thing is that we want to reinforce that people take the tablet every day. An occasional missed tablet is not going to greatly reduce the protection against HIV. The protection against HIV infection drops off significantly, when people are taking less than four tablets a week. In patients who are struggling to take the tablet on a regular basis, it’s great to be able to have some time to brainstorm ways to help ensure that this person can get into a routine of taking their tablet every day.
If somebody misses a tablet, they don’t need to double up the next day. Also, some patients are worried that if they have a particularly highly active period of sex, that they should double up on their medicines. This is not the case. A single tablet every day is the effective dose. There is no need to increase the amount of medicine taken, if there is an increase in sexual activity.