Health Tips

Supporting PrEP As A Preventive Medicine For All Malaysians

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.


Image source: Free Malaysia Today

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 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 you are no longer at risk for HIV infection.

It is recommended that once you’ve started taking PrEP, you should stay on it for at least 7 days 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), kindly talk to your doctor before stopping treatment altogether.

Alternatively, there is also an option where you take PrEP only when there is a high risk for HIV (not daily dose), known as On-Demand PrEP (PrEP 2-1-1). 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. This method is only effective in gay men and other men who have sex with men.

Image source: Take-Charge.Today

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. Studies have also demonstrated safe use in high risk patients who are HIV-negative. 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. 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

1. 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
2. PrEP & PEP - Malaysian AIDS Council. Available at: https://mac.org.my/v4/prep-pep/ . Accessed on 1st of February 2023
3. PrEP Basics - CDC. Available at: https://www.cdc.gov/hiv/basics/prep.html Accessed on 1st of February 2023
4. What is PrEP? -Medical News Today. Available at: https://www.medicalnewstoday.com/articles/prep-for-hiv Accessed on 1st of February 2023

Written By

Janelle Leong, Bpharm(Hons)