Glasgow 2024: Double dose start for oral PrEP in new EACS guidelines – rapid protection in two hours
14 November 2024. Related: Conference reports, Guidelines, HIV prevention and transmission, HIV 17 Glasgow 2024.
Laura Levi presenting updates to EACS PrEP guidelines at HIV Glasgow 2024.
Simon Collins, HIV i-Base
The latest update to the European HIV guidelines from EACS, released at the HIV Congress in Glasgow, includes a new recommendation that everyone should start PrEP with a double dose. [1, 2]
This is irrespective of sex, gender or whether subsequent dosing will be daily or on-demand.
The recommendation is based on providing rapid protection (within two hours) and is based on pharmacokinetic and pharmacodynamic studies. In last year’s guidelines, starting with a double dose was only recommended for cisgender men using on-demand 2:1:1 dosing. Otherwise, daily dosing for seven days was recommended for everyone else before relying on protection from daily PrEP.
The new guidelines still only recommend 2:1:1 dosing for cisgender men (and by implication transgender women, based on IPERGAY), with everyone else needing to continue daily PrEP for seven days before stopping.
This technically means that on-demand dosing should also be a new option for cisgender women using 2:7 dosing as recently recommended in the UK. However, this option is not proactively stated, and when the panel were asked directly about 2:7 on-demand dosing for women, no one could confidently reply. [3]
This might have been because the panelists hadn’t been personally involved in that section, but a case study by Jean-Michel Molina the day before had recommended 2:7 on-demand dosing for women. [4]
This year EACS are more confident to recommend that oral F/TAF could be used whenever F/TDF is not appropriate and that cabotegravir-LA can be considered when available.
They also recommend that regularly taking at least four doses of oral PrEP every week provides a high level of protection for both women and men, whereas daily dosing was previously needed.
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These dosing recommendations are similar to the UK BASHH/BHIVA draft recommendations released in October 2024. [5]
Making oral PrEP more practical, easier to plan and less stringent will hopefully increase the uptake among women.
The new guidelines still need to take care however to clarify dosing recommendations for transgender and non-binary people and even references to transgender women are not always consistent.
Please see the full guidelines for details, which also include a new section on chemsex.
References
- European AIDS Clinical Society (EACS). EACS HIV Guidelines 2024, v12.1.
https://www.eacsociety.org/guidelines/eacs-guidelines - The guidelines can only now be viewed using the EACS guidelines app or online:
https://eacs.sanfordguide.com - Ambrosioni J et al. Guidelines Session: 2024 Update and CV Risk Recommendations. Plenary session, HIV Glasgow 2024. Wednesday 13 November 2024.
https://virtual.hivglasgow.org/programme/prep-ing-future (webcast)
- Molina J-M. Clinical case study 1. HIV Glasgow 2024. Tuesday 12 November.
- Major update of UK PrEP guidelines online for public consultation.
https://i-base.info/htb/48804