2023-07-03 13:48:34
by Chiara Daina
It is a pharmacological therapy (it must be prescribed by the infectious disease doctor) which, together with responsible sex education, correct lifestyles and periodic screening, is effective in reducing the spread of HIV
Pre-exposure prophylaxis against HIV, known as prep, which a person negative for the virus takes before unprotected sexual intercourse to prevent the risk of contagion, has also become free in Italy since May. In the sense that the medicine is reimbursed to the citizen by the National Health Service, as in another twenty European countries. «But this does not mean a “free everyone” and therefore that one must feel authorized to have high-risk behaviors – warns Andrea Gori, professor of infectious diseases at the University of Milan and director of the infectious diseases department of the Sacco hospital in Milan -. Prep is a powerful tool to reduce the spread of HIV infection but drug therapy represents only a part of the prevention strategy, which includes other fundamental actions, such as safe sex education, information on correct lifestyles and on all other infections that can be transmitted sexually and the execution of periodic screenings for the diagnosis of these diseases”. The prep is not available to anyone who wants to take it. It is, in fact, a medicine subject to prescription by the infectious disease doctor and it is the specialist who determines whether the person is a candidate for therapy. «There is no target population but there are behaviors at high risk of exposure to the virus for which prophylaxis is indicated – explains Gori -. The selection is made on the basis of the number of sexual partners, the frequency of unprotected intercourse and the type. It also takes into account if the person practices chemex, or sexual acts in association with the consumption of drugs, and if he resorts to prostitution”. Citizens interested in prep must make an appointment (by mail or by telephone) at the infectious disease departments or centers for sexually transmitted infections. Access is free, which means that you don’t need a referral from your doctor. “Many people who turn to us don’t actually need therapy but only more information about their sexuality – says the infectious disease specialist -. For example, especially among young heterosexuals and homosexuals, there are those who, despite having a stable partner, are not sure of their fidelity and would like to protect themselves with prep. In this case, however, we recommend the use of condoms, the execution of a test for HIV and other sexually transmitted infections, the HPV vaccine and of course an open discussion with the partner. At the same time, the expert underlines “the fundamental role of the associations in information and guidance, also with respect to the reference structures that provide the treatment”.
The therapy with prep
The prep consists of a tablet that combines two antiretroviral drugs (which are already used in combination with other molecules in the treatment of HIV patients) in a single tablet. The methods of recruitment must be agreed together with the doctor. «Depending on the risk of contracting HIV – Gori points out – the therapy can be taken continuously or occasionally. If the administration schedule defined by the doctor is not followed correctly, total coverage from the infection is not guaranteed and there is a risk of catching an infection with a virus resistant to the antiretroviral drug”. The prescription is renewed from time to time and distribution takes place exclusively through hospital pharmacies. «The prevention strategy with prep also helps to reduce all other sexually transmitted infections because the user is constantly kept under control with specific screenings» highlights Gori. Pharmacological therapy, as we said at the beginning, is only one element of the programme. «When the user accesses the service, counseling is immediately given to investigate his sexual habits and inform him about the risks he runs, explaining that the prep does not protect against other sexually transmitted infections and that the condom is the only effective weapon against HIV and other pathologies that derive from unprotected relationships – remarks the infectious disease specialist at the Sacco hospital -. Then, in the same session, the user undergoes screening tests for syphilis, gonorrhea, chlamydia, mycoplasma, hepatitis a, b and c, and for HPV if he has not been vaccinated. In case of positivity, he is taken over for treatment. You will also need to take a blood test to check how well your kidneys are working. Prep is contraindicated, in fact, for those with kidney dysfunction. Every three months, those who take the prep continuously must repeat all the tests to intercept any new infections and any renal and bone toxicity induced by the drug. Finally, in case of addiction to alcohol and drugs, the patient is sent to the psychologist or psychiatrist of the centre”.
July 3, 2023 (change July 3, 2023 | 1:48 pm)
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