Supporting prep as a preventive medicine for all Malaysians

Published on: Thursday, February 02, 2023

By: DOC2US

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If you’re an avid follower of the everyday news, you must’ve heard of the inhibition of Pre-Exposure Prophylaxis (PrEP) to homosexual couples announced by the mufti a few weeks ago as it is thought to be encouraging “deviant” lifestyles.

This has raised several debates across the internet with allied passionate and dedicated healthcare professionals who advised against not providing PrEP pills for homosexuals, saying that the medication is essential to eradicate and minimize the rising rate of HIV infections in the country.

To understand what PrEP is and how it can prevent one from getting HIV, keep reading!

WHAT IS PREP?

Pre-Exposure Prophylaxis also known as PrEP for short is a type of prevention treatment designed for people who do not have HIV but are at risk of getting it such as those who:

Have a sexual partner(s) who are HIV positive

Received a sexually transmitted infection (STI) diagnosis in the last 6 months

Do not consistently use condom during sexual intercourse

Use injected recreational drugs and have the habit of sharing needles with others

Any of the above who are considering getting pregnant

In Malaysia, the oral PrEP — Truvada (emtricitabine/ tenofovir disoproxil fumarate) is commonly used and can be obtained at the selected local klinik kesihatan or hospitals upon thorough health screening and prescription from your physician.

The oral PrEP treatment is indicated to be taken once a day either before or after meals and they’re only available with a prescription. If one takes PrEP and they are exposed to HIV via unsafe sexual encounters or needle use, PrEP can keep the virus from establishing itself inside his/her body as long as treatment is initiated before possible exposure to HIV.

HOW EFFECTIVE IS PREP?

According to the Centers for Disease Control and Prevention (CDC), PrEP minimizes the risk of being infected by HIV from sex by approximately 99% and 74% effectiveness among injection drug users, provided users are taking them regularly as instructed by their physicians.

IS PREP SAFE FOR PREGNANT OR BREASTFEEDING MOTHERS?

Yes. If you or someone you know is pregnant or is breastfeeding and is at high risk of getting HIV, it is highly encouraged you consult your physician about PrEP if you’re not already on it. It may be a safe option to help protect you and your baby from getting HIV.

It is also safe for those who are on contraceptives either via pill, patch or ring to be on PrEP as there are no known interactions between the two.

DO I NEED TO TAKE PREP FOR THE REST OF MY LIFE OR ONLY TAKE IT WHEN I’M AT RISK OF BEING INFECTED BY HIV?

For optimum efficacy, it is recommended that you take PrEP at least once a day, ideally at the same time of the day. Good news is, with proper medical guidance and routine follow-up, PrEP does not have to be lifelong as long as your CD4+ count is within the desired range. It is recommended that once you’ve started taking PrEP, you should stay on it for at least a month after you were last exposed to HIV to ensure complete protection. This is because it generally takes a minimum of 7-21 days of daily use for it to achieve its peak therapeutic effect. If you think that you’re no longer at risk of getting HIV (change of lifestyle) and have completed a month’s course, kindly talk to your doctor before stopping treatment altogether.

Alternatively (effective only in men), there is also an option where you take PrEP only when there’s a high risk for HIV (not daily dose) also known as On-Demand PrEP (PrEP 2-1-1), making PrEP an option for more people to consider. On-Demand PrEP is the “2-1-1” schedule. This means taking 2 pills 2-24 hours before sexual intercourse, 1 pill after 24 hours of the first dose followed by 1 final dose 24 hours after the second dose.

WOULD I STILL NEED TO USE ADDITIONAL BARRIERS IF I’M ALREADY ON PREP?

Yes. PrEP can only stop you from getting HIV but it doesn’t necessarily protect you from other sexually transmitted diseases (STDs) such as chlamydia, syphilis, gonorrhea etc neither does it protect you from pregnancy. Hence, to be safe, it is always recommended that you practice safe sex measures in order to be sexually healthy and free.

SIDE EFFECTS

PrEP is generally safe and comes with very mild to 0 side effects. Studies have also demonstrated safe use in high risk patients who are HIV-negative for up to 5 years. Nonetheless, just like any other medicines, PrEP may bring some side effects to certain patients such as nausea, vomiting, fatigue and dizziness. For most, these side effects eventually go away after a while.

In some patients, Truvada is also seen increasing creatinine and transaminase levels in the body which would subsequently result in kidney problems. Another possible side effect from PrEP is a reduced bone mineral density within the first month of taking it. However, this is reversible as studies have found bone density to return to normal range once Truvada was stopped. It is therefore advised that those who are on PrEP to visit their doctors every 3 months for an HIV testing and follow-up care to ensure the kidneys and bones remain healthy and strong.

SUPPORTING PREP AS A PREVENTIVE MEDICINE FOR ALL MALAYSIANS

HIV, while not as common as other infections, can be serious as it will severely compromise our immune system and make us vulnerable to numerous opportunistic infections. Thus, proper education and awareness along with cooperativeness from all stakeholders is of utmost importance in minimizing the risk of HIV infections in Malaysia.

As a strong advocate of the 4 healthcare ethics (Autonomy, Non-maleficence, Beneficence and Justice), the Malaysian Medical Association (MMA) insisted on the importance of making PrEP accessible to everyone regardless of their sexual orientation or their lifestyle in order to fight against HIV as a country.

PrEP is registered and legal in Malaysia and is part of the National Strategic Plan to end AIDS by 2030. Different religions may have varying views on the use of PrEP, however, the reality is that HIV requires a non-religious intervention and prevention program.

This article is written by Janelle Leong, Bpharm(Hons) (DOC2US),

reviewed by Dr. Ahmad Haniffan, MBBS (DOC2US)

REFERENCES

Pre-Exposure Prophylaxis (PrEP) - Stanford Medicine. Available at: https://stanfordhealthcare.org/medical-conditions/sexual-and-reproductive-health/hiv-aids/treatments/prep.html. Accessed on 1st of February 2023

PrEP & PEP - Malaysian AIDS Council. Available at: https://mac.org.my/v4/prep-pep/ . Accessed on 1st of February 2023

PrEP Basics - CDC. Available at: https://www.cdc.gov/hiv/basics/prep.html Accessed on 1st of February 2023

What is PrEP? -Medical News Today. Available at: https://www.medicalnewstoday.com/articles/prep-for-hiv Accessed on 1st of February 2023