UK guide to PrEP now online: major update (2024)
1 March 2024. Related: Editorial, Special reports.
Simon Collins, HIV i-Base
The 10th edition of this guide includes significant changes that make PrEP easier to take. This is an exciting time for PrEP.
- Everyone who can benefit from PrEP in the UK should now be able to get it at an NHS clinic. You no longer have to be at high risk.
- Everyone now has the option to quick-start PrEP using a double first dose (two pills), working within two hours.
- Event-based dosing can also now be used by everyone. This uses either 2:1:1 or 2:7 dosing.
- New info covers starting and stopping PrEP and new versions of PrEP (TAF/FTC and injectables).
- UK guidelines in 2024 might include additional recommendations that could make PrEP even easier. This includes that people who currently need 6-7 daily doses a week might only need 4 or more.
The changes are based on recent studies that update our understanding of how PrEP works. Instead of needing to have good drug levels in vaginal or anal tissue, PrEP efficacy is now explained by drug levels in cells called PBMCs. [1]
Because drug levels in PBMCs are not affected by sex or gender, there are now easier dosing options for cisgender women and for people who are transgender and non-binary.
Other studies show that everyone can now quick-start PrEP with a double dose (two pills) to be protected within two hours. [2, 3]
Since 2022 the IAS-USA guidelines have recommended a double-dose start for cis males (with at least two daily doses after sex) and daily dosing for seven days after sex for all other groups, although the 2:7 regimen has not to date been recommended in any published guideline. [4]
A large meta-analysis published in JAMA also supported significant protection in women using less than daily dosing. [5]
These changes should also be included in the upcoming UK PrEP Guidelines (BHIVA/BASHH), which are currently being updated. A draft of the guidelines should be made available shortly for comment.
References
- Zhang L et al. Model-based predictions of protective HIV pre-exposure prophylaxis adherence levels in cisgender women. Nat Med. 2023 Nov;29(11):2753-2762. doi: 10.1038/s41591-023-02615-x. (13 November 2023).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10667095 - Cottrell ML et al. A translational pharmacology approach to predicting outcomes of preexposure prophylaxis against HIV in men and women using tenofovir disoproxil fumarate with or without emtricitabine. J Infect Dis. 2016 Jul 1;214(1):55-64. doi: 10.1093/infdis/jiw077. Epub 2016 Feb 24.
https://pubmed.ncbi.nlm.nih.gov/26917574 - Garrett KL et al. A pharmacokinetic/pharmacodynamic model to predict effective HIV prophylaxis dosing strategies for people who inject drugs. J Pharmacol Exp Ther. 2018 Nov;367(2):245-251. doi: 10.1124/jpet.118.251009. Epub 2018. (27 August 2018).
https://pubmed.ncbi.nlm.nih.gov/30150483 - IAS-USA. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2022 Recommendations of the International Antiviral Society–USA Panel. JAMA. 2022; doi:10.1001/jama.2022.22246. (1 December 2022).
https://www.iasusa.org/2022/11/30/antiretroviral-drugs-treatment-prevention-hiv-infection-adults-2020-recommendations-of-the-international-antiviral-society-usa-panel-2022/ (webpage - Marrazzo J et al. HIV Preexposure Prophylaxis With Emtricitabine and Tenofovir Disoproxil Fumarate Among Cisgender Women. JAMA. doi:10.1001/jama.2024.0464. (1 March 2024).
https://jamanetwork.com/journals/jama/fullarticle/2816036
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HIV i-Base