Arnold Solof, MD

PrEP and PEP to Prevent HIV

Definitions:

• PrEP = Pre-exposure Prophylaxis
• PEP = Post-exposure Prophylaxis

PEP

It seems that not so long ago there was post-exposure prophylaxis for HIV, but we didn’t have good data on it to confirm that it worked or how well it worked.  We did it because it made sense and was the best we could do.  Now, this has been studied reasonably well and we have confirmation of its efficacy.  It is not cheap, but it is frequently covered by medical insurance or the liability policies of our employers.

So what are some examples of exposure that one would want Post-exposure prophylaxis?

1. think you may have been exposed to HIV during sex (for example, if the condom broke)
2. shared needles
3. were sexually assaulted

Detailed Information on PEP from the CDC

PrEP

Even newer is the development of protocols/treatments that prevent HIV before exposures to it.  It is also expensive but frequently covered by insurance.

What are some examples of situations in which you would consider Pre-exposure prophylaxis?

1.  Daily PrEP use can lower the risk of getting HIV from sex by more than 90% (eg. HIV Infected Sex Partner or live in an area with a high incidence of HIV)
2.  Daily PrEP use can lower the risk of getting HIV from injection drug use by more than 70%

Detailed Information on PrEP from the CDC

The drugs used have occasional side effects and some people may not be able to use them because of this.

Although not perfect, until we get an effective vaccine, it is a useful tool/option to have.

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Arnold Solof, MD

I was just reviewing information on methods to prevent HIV infection.  In a recent trial of a candidate vaccine, it was found to have “only” 30% efficacy in preventing HIV infection (so it was deemed not effective).  The presenter was a world-recognized specialist in pediatric infectious diseases.

Upon hearing that I recalled numerous reports over the past few months stating that the Flu vaccine for the 2017-2018 season was only about 10% effective (note: more recent estimates are around 33% efficacy).  Yet, the infectious disease specialists were recommending everyone get the Flu vaccine despite the believed 10% efficacy.  Their position was “10% is better than zero”.  I thought, Wow! 10%.  Whoopie!  I was having a hard time getting excited about that.

So, although both infections can kill you, given the choice, I’d take my chances with influenza before I would with HIV and I find it interesting how the efficacy assessments of these 2 scenarios seem reversed. I can’t help but think that in this case, the medical profession guilty of the same kind of prejudice we accuse our patients of when it comes to Flu vaccines.  Did we stop and think before we spoke?

HIV Vaccine Development

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