PrEP is a pill which contains HIV inhibitors which can prevent an HIV infection. The pill is meant for people who are not living with HIV, but who run a high risk of infection. PrEP is short for Pre-Exposure Prophylaxus. This means you take it before you are exposed to a pathogen. PrEP consists of one pill, Truvada. It contains two medications which are also used for HIV treatment: emtricitabine and tenofovir disoproxil. PrEP makes it more difficult for HIV to infect cells and to multiply. This considerably reduces the risk of an HIV infection.
The project aims to investigate the use of PrEP (Pre-Exposure Prophylaxus) for HIV prevention. The research focuses on how many homosexual men and transgender people want to use PrEP, whether they adhere to the therapy, the experiences of people using PrEP overall, and whether it affects condom use. It is the first time that PrEP is being investigated in the Netherlands and our project is the first to offer participants a choice: using PrEP on a daily basis or using PrEP according to a fixed schedule around sex. GGD Amsterdam will use the project results to advise on whether to adopt PrEP as a standard intervention for HIV prevention in the Netherlands.
For more information about the Amsterdam PrEP project, visit: http://www.ggd.amsterdam.nl/english/sti-hiv-and-sense-0/prep/
In the past few years, the number of people newly infected with HIV has slightly decreased. Every year some 900 people are diagnosed with an HIV infection in the Netherlands, including 162 people in Amsterdam (2015).
In 2015, 65 of new HIV infections were found in homosexual men. That is why this group and transgender people, some of whom also run a higher risk of being infected with HIV, have been selected as target groups for this first research project.
New HIV infections still occur, in spite of many educational activities about safer sex, the availability of cheap condoms, and the healthcare services available for people who run a higher risk of contracting HIV organised through the STD polyclinics, such as free testing. To further decrease the number of new HIV infections, new methods like PrEP are needed. PrEP complements existing prevention strategies such as condom use and regular testing for HIV and other STDs.
Between August 2015 and June 2016, 376 people started taking PrEP: 374 homosexual men and other men who have sex with men, and two transgender women. Of them, 273 started to use PrEP on a daily basis.
The other participants chose to take PrEP occasionally, that is, around sex. During a period of three years, the STD polyclinic of GGD Amsterdam is monitoring and guiding them, offering them STD, HIV and other tests, as well as counselling.
From August 2015 through May 2018, PrEP is being provided to the study participants. After this, until 1 December 2018, the participants will visit the STD polyclinic twice more. During the project’s run, interim findings will be made known, and the final results will be published at the beginning of 2019.
During the screening visits, we detected an STD in about 20 per cent of all participants. Unfortunately, one person appeared to be HIV-positive during the screening visits. Nobody had an acute HIV infection at the time he or she started using PrEP. In eighteen participants we found a Hepatitis C infection, a virus which causes inflammation of the liver and for which there isn’t a vaccination available yet. In three of these eighteen people, the infection had been treated or cured by itself, and fifteen people were still living with the Hepatitis C virus. Ten people were unaware that they were infected with the Hepatitis C virus. Every participant who still had the Hepatitis C virus was referred to hospital for treatment. These people can continue taking PrEP and continue participating in AMPrEP. Science magazine AIDS published an article about this in July 2017. GGD Amsterdam will use the project results to advise on whether or not to adopt PrEP as a standard intervention for HIV prevention in the Netherlands.