In short Article

PrEP effectively reduces risk of HIV infection, provided it is used with care


The Dutch Minister for Medical Care and Sports has recently announced that the financial resources for care associated with so-called pre-exposure prophylaxis (PrEP) will be allocated to Dutch regional public health services (GGDs) as of 1 August 2019. This subsidy is to be used for the provision of the required antiretroviral agents and the associated medical care. PrEP is used to reduce the risk of HIV infections for persons who do not have HIV, but who are at high risk of it. This includes, for instance, men who have sex with men who exhibit hazardous behaviour. PrEP halves their risk of HIV, but only if the PrEP medication is taken according to prescription and in combination with other, obvious measures like the use of condoms. The use of PrEP could then be a cost-effective measure to reduce the number of new HIV infections. In addition to the regional public health services, general practitioners could in principle also provide this form of HIV prevention. The budget offered by the Ministry is limited, however, which means that users will have to bear part of the costs themselves.

  • Provided it is used as intended, PrEP can at least halve the risk of HIV infection. 
  • If compliance is poor, the risk-reducing effect of PrEP may be reduced to below 33%.
  • PrEP medication can be taken in two different ways: daily, for all high-risk groups, or intermittently, only prior to unprotected sexual contacts, for men from the high-risk group who have unprotected sexual contacts among themselves.
  • Persons who are going to start PrEP need to be warned about the possible adverse effects of nausea, vomiting and reduced renal function.
  • Before and during the use of PrEP the users need to be checked for the presence of hepatitis B and C, HIV and other STDs, and for reduced renal function.
  • Together with pharmacists, general practitioners could provide the care associated with PrEP, if it should be problematic for the user to obtain it from a regional public health service.

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*The literature refers to the Dutch text

Authors

  • mw S. van der Heijden MSc