Major update of UK PrEP guidelines online for public consultation
1 October 2024. Related: Special reports, Guidelines, HIV prevention and transmission.
Simon Collins, HIV i-Base
On 27 September 2024, the long-awaited BASHH/BHIVA PrEP guidelines were posted online for public consultation as a 90-page draft with more than 80 recommendations and more than 50 good practice points.
The results are a dynamic challenge to other national and international guidelines to similarly respond to recent research that offers easier options for PrEP dosing for many people in key populations.
This includes the option for everyone to start PrEP using a double dose to have rapid protection within two hours.
Up until now, cisgender women – and trans and non-binary people – have had to take daily PrEP for a week before achieving protection.
Also new, anyone who used at least four doses of PrEP the week before, only needs four doses the subsequent week if stopping PrEP. As a caution though, if PrEP wasn’t used the week before, cis women, trans and non-binary people are advised to take daily PrEP for seven days when they want to stop.
Several recent studies show that something special happens with a double dose of oral PrEP. Drug levels not only reach protective levels within two hours, but keep levels high for 5-10 days.
The guidelines recognise the importance of research showing that PrEP efficacy is more closely linked to drug levels inside cells (PBMCs) than drug levels in genital and rectal tissue. As well as questioning the need for dosing differences by sex and gender, this supports PrEP working systemically, which strengthens the rationale for efficacy against exposure from shared injecting drug use.
The guidelines also say that the same dosing recommendations can be used for both the current versions of oral PrEP – F/TDF and F/TAF.
Importantly, these guidelines are focussed throughout on equalising access to PrEP across all populations and risk groups who often have lower knowledge of, access to, and uptake of PrEP. This includes young people, those from ethnically minoritised communities, heterosexual men and women, trans and non-binary people and people who inject drugs. They also include a new chapter focussed on equity.
The guidelines are essential reading, fully referenced, and includes looking forward to long-acting injectable PrEP using cabotegravir-LA and lenacapavir.
The two-month open public consultation ends on 26 November 2024.
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A community guide by i-Base and others was published in February based on the same research, and working with key members of the guidelines panel. [2]
This resource is online as a non-technical review of the same recommendations.
Reference
- BHIVA/BASHH. BHIVA/BASHH. guideline on the use of HIV pre-exposure prophylaxis – 2024: Draft out for consultation. (27 September 2024).
https://www.bashh.org/resources/126/bhivabashh_guideline_on_the_use_of_hiv_preexposure_prophylaxis_2024_draft_out_for_consultation (web page)
https://www.bashh.org/_userfiles/pages/files/draft_bashh_bhiva_prep_guidelines_240924_v30_final.pdf (PDF direct link) - i-Base and others. UK guide to PrEP. (February 2024).
https://i-base.info/uk-guide-to-prep-february-2024/