India has the second-largest HIV burden in the world, with an estimated adult prevalence of 0.22% and 23.19 lakh people living with HIV (PLHIV) in 2020. Currently, the country is estimated to have an annual HIV incidence of 0.04 per 1,000 uninfected population. 

World Health Organization (WHO) recommends that people at substantial risk of HIV should be offered oral PrEP.  PrEP refers to the use of antiretroviral medication to reduce the risk of acquiring HIV, especially among individuals who are at high risk of HIV. 

Pre-exposure prophylaxis (PrEP) is a medicine taken by those who are at high risk of getting HIV infection. When PrEP is taken consistently and correctly, antiretroviral drugs enter the bloodstream, the genital and the rectal tissues. Once the drug reaches optimal levels in the body and tissues, and is consistently maintained at that level, it prevents replication of the virus within the immune cells and protects individuals from acquiring HIV.  

Current evidence suggest, that, it takes at least 7 days of consistent use of PrEP to achieve the optimum level for protection in anal receptive sex while at least21 days of consistent use of PrEP, for protection in vaginal receptive sex. 

If it is taken as per the doctor’s prescription, it helps in reducing the chances of getting HIV infection through sex by 99% and through injecting drugs by 74%,which makes it highly effective against HIV. It is much less effective when itis not taken as per the prescription. It is important to note that PrEP protects only against HIV and not any other STD.  

Eligibility for PrEP: To be eligible for PrEP, persons must meet all the following criteria:

● Confirmed HIV negative test

● At substantial risk of acquiring HIV infection 

● No contraindication to use of any medication used for PrEP

● Does not have a current or recent(within past one month) illness suggestive of acute HIV infection along with history of probable exposure for HIV.

● Assessed as ready to adhere to PrEP and willing to attend follow-up evaluations including repeated HIV testing and monitoring.

Contraindications to PrEP: Following are the situations wherein PrEP should not be initiated or continued:

●Confirmed HIV infection

● Signs/symptoms of acute HIV infection

●Weight below 30 kg

● Altered renal functions (estimated creatinine clearance< 60 mL/min)

●Unwillingness/unable to take3-monthly HIV testing, counselling and safety monitoring visits

● Unwillingness or unable to adhere to PrEP

Who should take PrEP?

It is recommended for those who are HIV negative but are at higher risk of getting HIV infection.

● People with HIV positive partners

● People having sex without condom

● People with history of STI

● People who inject drugs

● People with history of taking PEP 

How to take PrEP?

There are 2 ways of taking PrEP:-

1) Daily PrEP:- An oral pill is taken daily regardless of sexual activity.

2) On Demand PrEP:- “2-1-1 dosing” Two pills are taken 2 to 24 hours before having potential HIV exposure, followed by 1 pill 24hours after the first dose, and another pill 24 hours later.

Side effects 

That may be experienced by PrEP users include, Especially when it’s taken without medical supervision 

● Gastrointestinal side-effects: -Nausea, Vomiting, or abdominal discomfort

● Renal toxicity: Proteinuria, decreasing glomerular filtration rate (GFR) and Fanconi’s syndrome

● Decreased bone mineral density