After more than a decade of existence of the treatment that prevents HIV, better known as Pre-exposure Prophylaxis (PrEP), the Spanish Society of Immunology published new recommendations for the clinical use of this therapy in that nation.
This strategy, which consists of an antiretroviral treatment that can be taken by those who do not live with HIV, but are constantly exposed to it, has been widely studied in different circumstances to find out if it continues to be safe and effective in different contexts and populations.
A before and after
In 2010, the first scientific study was published that showed that antiretroviral treatment was not only effective in stopping HIV in the body, but that it was also capable of preventing the infection from establishing itself in a person without the virus who consistently took the drug treatment, even if they had sexual contact with HIV.
It was in 2012 that the Food and Drug Administration (FDA) gave the first approval to provide PrEP to groups of people at high risk of contracting HIV, specifically men couples of men living with HIV and dedicated individuals to sex work.
The antiretroviral regimen used to develop PrEP remained unchanged for a long time, consisting of a daily pill. In recent years, other options have emerged, both for drugs and doses, since there is currently an injection that is applied every two months, although it has only been approved in the United States and some European countries.
As a result of the investigations on PrEP that have been carried out in recent years, the Spanish Society of Clinical Immunology and Microbiology, through its AIDS Study Group, updated its recommendations on the use of the treatment. This was reported by the website of the Working Group on HIV Treatments (gTt-HIV).
Although the new guidelines, published last March, are applicable only in the Iberian country, they serve as a parameter to consider the changes that may occur in the guides of other countries.
In the document, which had not been updated since 2016, the objective of the follow-up visits was modified. Follow-up visits a year are typically completed by those receiving PrEP, but until now this has been used to provide three months’ worth of medication and to test them for HIV (as PrEP, while highly effective, is not foolproof).
The guidelines now specify that follow-up visits should be taken as an opportunity to analyze the characteristics of each case, and should include:
– Preventive counseling beyond PrEP
– Evaluation of possible adverse effects
– Tests to detect other sexually transmitted infections (STIs)
– Detection of drug use
– Review of the person’s vaccination scheme
Largest covered population
Regarding the population that can receive PrEP (which since 2019 has been part of the services of the National Health System in Spain), the new guidelines indicate that the treatment can now also be given to people who use injected drugs and to men and women cisgender who are at risk of acquiring HIV.
The groups to which this treatment was mainly directed are maintained; these are:
– Gay, bisexual and other men who have sex with men
– Trans women
– Women sex workers
Likewise, the minimum age of 16 years, newly established in 2021, remains unchanged (previously PrEP was only given to people 18 years of age or older).
The update also included the particularities of chemsex, that is, parties of sexual exchange where certain drugs are used. For people with these practices, comprehensive care is recommended that avoids moral judgments, discrimination or stigmatization due to drug use, but providing help tools for those who want to stop using or to reduce its damage.
Another very important topic that is addressed is adherence, which means taking the treatment in a timely manner, without errors and without interrupting it, as this is the key to the success of PrEP. It should be said that in Spain the only type of PrEP that will continue to be used is the scheme of a daily pill.
Without a doubt, there are very effective options to prevent HIV, but the cheapest, most practical and within reach is the condom. Remember that at AHF Latin America and the Caribbean we have them for you. In addition, we do free HIV tests. If you want to know more, locate our offices near you, we are in 11 countries in the region.