There are several HIV prevention measures relied on and they include the use of Pre-exposure Prophylaxis, Post exposure Prophylaxis and Dapivirine Vaginal Ring (PrEP, PEP and DVR.) These have played significant role in the prevention of HIV contraction among serodiscordant couples and at risk populations.
PrEP is short for Pre-Exposure Prophylaxis.
It is used as antiretroviral medication to prevent HIV by people without HIV who may be exposed to HIV through sex or injection drug use.
The US Food and Drug Administration (FDA) has approved three medications for use as PrEP, which are listed below. Two consist of a combination of drugs in a single oral tablet taken daily. The third medication is a medicine given by injection every 2 months.
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- Emtricitabine (F) 200 mg in combination with tenofovir disoproxil fumarate (TDF) 300 mg (F/TDF – brand name Truvada® or generic equivalent).
- Emtricitabine (F) 200 mg in combination with tenofovir alafenamide (TAF) 25 mg (F/TAF – brand name Descovy®).
- Cabotegravir (CAB) 600 mg injection (brand name Apretude®).
These medications are approved to prevent HIV infection in adults and adolescents weighing at least 35 kg (77 lb) as follows:
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- Daily oral PrEP with F/TDF is recommended to prevent HIV infection among all people at risk through sex or injection drug use.
- Daily oral PrEP with F/TAF is recommended to prevent HIV infection among people at risk through sex, excluding people at risk through receptive vaginal sex. F/TAF has not yet been studied for HIV prevention for people assigned female at birth who could get HIV through receptive vaginal sex.
- Injectable PrEP with CAB is recommended to prevent HIV infection among all people at risk through sex. It may be especially useful for people who have problems taking oral PrEP as prescribed, who prefer getting a shot every 2 months instead of taking oral PrEP, or who have serious kidney disease that prevents use of oral PrEP medications.
Post-Exposure Prophylaxis (PEP)
Is the use of antiretroviral medication to prevent HIV infection in an HIV-negative person who has had a specific high-risk exposure to HIV. Exposure to HIV is a medical emergency because HIV establishes infection very quickly often within 24 to 36 hours after exposure.
Health care providers should evaluate persons rapidly for PEP when care is sought within 72 hours after a potential exposure.
PEP initiation should be considered in people whose vagina, rectum, eye, mouth or other mucuous membrane, non-intact skin, or perforated skin (eg, needle stick) come into contact with potentially contaminated body fluids from an HIV-infected source, as long as exposure has occurred within a 72-hour window.
All persons offered PEP should be prescribed a 28-day course of a 3-drug antiretroviral regimen. Since adherence is critical for PEP efficacy, it is preferable to select regimens that minimize side effects, number of doses per day and the number of pills per dose. The preferred PEP regimen for otherwise healthy adults and adolescents is tenofovir disoproxil fumarate (TDF) (300 mg) + emtricitibine (FTC) 200 mg) once daily PLUS raltegravir (RAL) (400 mg) twice daily or dolutegravir (DTG) (50 mg) once daily).
Similarly, Dapivirine Vaginal Ring 25 mg is a vaginal ring used to reduce the risk of a woman getting infected with human immunodeficiency virus type 1 (HIV-1) through vaginal intercourse. Dapivirine Vaginal Ring 25 mg contains the active substance Dapivirine in a silicone ring that is inserted into the vagina and slowly releases the dapivirine, an antiviral medicine, over the course of one month. The ring should be removed after four weeks of use, and replaced straight away with a new ring.
