Question
Am I protected after 6 daily doses of PrEP?
5 August 2024. Related: Adherence, All topics, PrEP.
I started taking PrEP 6 days ago, but today i had an exposure and i didn’t know i had to take PrEP 7 days before to be protected. My question is, am still protected with the 6 days of daily dosing? Or what should i do?
Answer
Hi there
Please don’t worry. Many guidelines about how to use PrEP are not based on the latest research and information. This might include the leaflet that comes with PrEP and many community leaflets.
Recent studies include different recommendations for the number of doses someone needs to take befor being protected.
In the UK, everyone has the option to start PrEP with a double dose (two pills) and to be protected in only two hours.
Other studies have reported that so long as someone takes four or more daily doses in a week, they will have a very high level of protection.
This includes cisgender women and trans people who are sometimes still told they need to take daily PrEP for seven days before they are protected.
More recent research – maybe not eben know by your doctor – has shown that sex an gender to not matter when deciding how you want to take PrEP.
This i-Base guide explains everything in more detail.
https://i-base.info/uk-guide-to-prep-february-2024/
Hello Miguel and thanks for getting in touch.
PEP is the medication you want to take after a risky encounter for sure.
PEP is a combination of 3 antiretrovirals.
You need to continue on it for 4 weeks and take it every day as it was prescribed and around the same time every day.
PrEP is a medication you can take before you have a risky encounter.
PrEP is a combination of 2 antiretrovirals.
You can take it daily or on demand (or event based), according to your habits and lifestyle.
You should always start with a double dose even if you prefer to take it daily.
Well done for that.
If you are a cis-gender man then you need to take the first double dose up to 2 hours before you have sex and continue daily with a single dose every day (around the same time you took the first dose) until 2 whole days have passed after the last time you had sex.
The protection is immediate provided you follow the above.
You can see more information here: https://i-base.info/uk-guide-to-prep-february-2024/
And for examples on dosing: https://i-base.info/guides/prep/real-life-examples-for-on-demand-dosing
Hello. I had a risky encounter 7 weeks ago. I was started on PEP for a month but I was quite inconsistent with taking the medication. I am on PrEP now but still I am not taking it every day. I took a 4th-generation test this week (ECLIA for HIV-1 and HIV-2 antibodies and p24 antigen), and the result was non-reactive.
After receiving the result, I decided to restart PrEP and commit to taking it more consistently. I began with a double dose. Is this correct? Do I need to wait weeks to get effective protection? Thanks.
Hi Felipe, thanks. If you are routinely taking 4 PrEP doses every week, it doesn’t matter when you have sex. If you miss a week though, just restart with a double dose (2 pills) at least two hours before you have sex.
All the oral PrEP studies in gay and bisexual men included all types of sex and many people both top, bottom and side :)
Please see this guide for more info which has references if you want more technical details:
https://i-base.info/uk-guide-to-prep-february-2024/
Hello Simon. I’ve got 2 questions. (1) I’ve been taking PrEP for the last 3 months, but to be honest, I sometimes forget to take 2 or even 3 doses per week. I’ve read some answers from you and other sities that say 4 doses per week offer very good protection. What I still don’t understand is how far these doses can be spaced from the last risk exposure. For example, if one of these weeks I take PrEP on Monday, Tuesday, Wednesday, and Thursday, but miss it on Friday, Saturday, and Sunday, and then I have unprotected sex on Monday, would the 4 previous doses still provide protection?
(2) Also, the studies I’ve read focus on rectal tissue, so the efficacy of Truvada has been mainly determined for bottom men. What about for top men? Do scientists assume the same level of protection for topping?
Thanks for your clarity!