Until now reserved for hospital doctors or practicing in free information, screening and diagnostic centers (CeGIDD), it will be possible from June 1, 2021, for any doctor – including general practitioners – to ensure the initial prescription of PrEP, announces this May 28 the Ministry of Health. The objective is to simplify the process for those concerned and improve access for those most at risk of HIV. “Covid-19 should not overshadow other epidemics, starting with that of HIV. The deployment of PrEP in the city is a long-standing request from the associations that we honor today. It is an important public health decision which will facilitate patient access to this treatment, and will I am sure have a significant impact on contaminations”, declared Olivier Véran, Minister of Solidarity and Health.
As of June 30, 2019, 20,478 people had initiated HIV pre-exposure prophylaxis (PrEP) according to the National Agency for the Safety of Medicines and Health Products (ANSM) – a figure that has risen sharply since 2016. 98% of the patients are homosexual men, aged 38 on average.
PrEP (Truvada): what is HIV pre-exposure prophylaxis?
First thing to know: HIV pre-exposure prophylaxis (PrEP) is a drug treatment that protects against infection with the human immunodeficiency virus (HIV), which causes AIDS.
PrEP is for people who are HIV-negative (i.e., do not have HIV) who have sex with people who are HIV-positive (i.e., have HIV infection) or whose HIV status is n is not known (who are therefore potentially HIV-positive). It is a tool that helps protect against AIDS.
PrEP is a drug (which comes in the form of blue tablets) to be taken orally: in pharmacies, it is available under the trade name of Truvada®. There are also generic drugs: Emtricitabine/Tenofovir Disoproxil®, for example.
Warning ! Do not confuse PrEP (Truvada® and generics) with post-exposure treatment (TPE) which is also intended for HIV-negative people but which is taken after high-risk sex. PrEP is also not the same thing as Treatment as Prevention (TasP) : the latter corresponds to the treatment taken daily by HIV-positive people to reduce the amount of HIV in the body – we speak of “reducing the viral load”.
To know. It’s proven: an HIV-positive person on treatment (TasP) and who has an undetectable viral load does not transmit HIV to his, her, or his partners.
PrEP (Truvada): who is it for?
While the majority of patients treated with PrEP are men who have sex with men, Truvada® can be prescribed to all HIV-negative people who have sex considered “at risk” by health authorities. According to the Haute Autorité de Santé (HAS), PrEP is particularly aimed at men and women.at high risk of contracting HIV“, that is to say :
- men who have sex with men,
- transgender people who have had anal sex without a condom with (at least) 2 different sexual partners in the last 6 months,
- to sex workers having unprotected sex,
- people who have unprotected sex with someone infected (or potentially infected) with HIV.
[ENQUETE] See the report by TopSanté TV : “For or against PreEP?”
PrEP (Truvada): how does it work?
The drug Truvada® and its generics combine two antiretroviral molecules active against the human immunodeficiency virus (HIV): emtricitabine and tenofovir disoproxil. These substances “block” the activity of an enzyme of the virus (retrotranscriptase or reverse transcriptase), which prevents the reproduction of HIV in infected cells.
Truvada®: contraindications. PrEP (Truvada® and generics) can be prescribed from the age of 12, in adolescents weighing more than 35 kg. This treatment is contraindicated in cases of moderate to severe renal insufficiency. It is not recommended for pregnant or breastfeeding women.
Truvada®: side effects. Tenofovir (one of the two active ingredients in the drug Truvada®) can be toxic to the kidneys: the kidney health of patients on PrEP is therefore subject to increased monitoring.
In addition, in cases of immunosuppression, obesity, excessive alcohol consumption or taking corticosteroids, PrEP can be the cause of bone damage – which manifests itself through pain in the hip. , knee and/or shoulder, walking difficulties and/or joint stiffness. Finally, it is not recommended to drive while being treated with PrEP because this drug can cause dizziness.
As for “frequent” and “very frequent” side effects (which concern between 1% and 10% of patients), we can cite digestive disorders (diarrhea, vomiting, abdominal pain, nausea, etc.), insomnia and nightmares, and dermatological disorders (hives, itching, rashes…).
PrEP (Truvada): in practice
HIV pre-exposure prophylaxis (PrEP) can be taken on an ad hoc basis (when you know you are going to have sex with an HIV-positive or potentially HIV-positive person, for example) or regularly (when you have regular unprotected sex with people whose HIV status is unknown or who have HIV, for example).
- If PrEP is taken on an ad hoc basis, the usual dosage is 2 tablets at least 4 hours before sexual intercourse, then 1 tablet per day for 2 days after the risky intercourse.
- If PrEP is taken regularly, the usual dose is 1 tablet per day.
Warning ! Truvada® is only available on prescription: this medicine is not sold over the counter. To obtain a prescription, it is possible to meet with a doctor specializing in HIV infection (at the hospital or in a CeGIDD offering PrEP consultations) or any other doctor, including a general practitioner, then take a blood test ( screening for HIV, hepatitis and STIs, renal assessment).
After the first prescription, renewal can be done by a general practitioner. Quarterly monitoring is in place for people on PrEP treatment.
To know. PrEP (Truvada® and generics) is 100% reimbursed by Health Insurance for people “at high risk of contracting HIV“.
PrEP (Truvada): does it really work? Yes. Several studies have thus demonstrated the effectiveness of PrEP in continuous and occasional doses: Iprex Ole (United States), Partners Prep (Kenya, Uganda), Proud (United Kingdom), ANRS-Ipergay (France, Canada) . All these studies show that when the drug is taken correctly according to the indicated schedule, the risk of HIV contamination is minimal.
Thanks to Jean Spiri, president of the Regional Center for AIDS Information and Prevention and for Youth Health (Crips) Île-de-France.
Sources:
- HIV.org
- ANSM
- Vidal Encyclopedia
- Aids
- High Authority for Health (HAS)
- Crips Ile-de-France
- European Commission
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