i-Base

UK guide to PrEP (February 2024)

13 February 2024. Related: Guides, News.

The 10th edition of this guide to 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 later in 2024 might include additional recommendations that could make PrEP even easier.

The changes are based on recent studies that update our understanding of how PrEP works. Instead 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 double dose (two pills) to be protected within two hours. [2, 3]

These changes should also be included in the upcoming UK PrEP Guidelines (BHIVA/BASHH) that are currently being updated. A draft of the guidelines should be made available shortly for comment.

Note: UK guidelines are now online, together with similar European guidelines from EACS. [6, 7]

References

  1. 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
  2. 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
  3. 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
  4. Cespedes MS et al. (2024) Gender affirming hormones do not affect the exposure and efficacy of F/TDF or F/TAF for HIV preexposure prophylaxis: a subgroup analysis from the DISCOVER trial Transgender Health 9:1 46–52 DOI: 10.1089/trgh.2022.0048.
    https://www.liebertpub.com/doi/full/10.1089/trgh.2022.0048
  5. 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
  6. Major update of UK PrEP guidelines online for public consultation. (HTB October 2024).
    https://i-base.info/htb/48804
  7. Glasgow 2024: Double dose start for oral PrEP in Europe – rapid protection in two hours. (HTB November 2024).
    https://i-base.info/htb/49351