PrEP: preventive treatment is an alternative in the fight against HIV in Brazil

The National Health Surveillance Agency (Anvisa) recently approved the registration of the first injectable drug for HIV prevention. Apretude (cabotegravir) is an antiretroviral from the integrase enzyme inhibitor class, which prevents the insertion of HIV viral DNA into human DNA. In other words, it is a mechanism of action that prevents the virus from replicating or reproducing and its ability to infect new cells.

The injectable drug now represents a new option in pre-exposure prophylaxis (PrEP) in Brazil, which until then consisted of taking daily pills in order to allow the body to be prepared to face a possible contact with HIV. The strategy began to be offered by the Unified Health System (SUS) at the end of 2017 through the combination of two antiretrovirals, tenofovir and emtricitabine.

Art/Agency Brazil

Understand

PrEP is currently indicated for sexually active, uninfected people, but at increased risk of exposure to HIV, in different social contexts. In Brazil, these populations include sex workers, people who use drugs, gay men, trans women and transvestites, in addition to serodiscordant couples (when one partner is seropositive and the other is not), as a complementary form of prevention and for reproductive planning.

Modalities

In Brazil, there are two types of PrEP indicated: daily: consists of taking pills daily, continuously, indicated for anyone in a situation of vulnerability to HIV; on-demand: consists of taking the medication only when the person has a possible risk exposure to HIV. It should be used by taking two pills two to 24 hours before sexual intercourse, plus one pill 24 hours after the initial dose of two pills and a new pill 24 hours after the second dose.

On-demand PrEP is indicated for people who habitually have sex less than twice a week and who can plan when to have sex.

care

According to the Ministry of Health, PrEP only has a protective effect if the drug is used as directed by a health professional. Otherwise, there may not be enough concentration of the active substances in the individual’s bloodstream to block the virus.

In addition, all types of pre-exposure prophylaxis should only be prescribed to confirmed HIV negative individuals.

“For the indication of the use of any PrEP therapy, the previous diagnosis of HIV infection must be excluded clinically and laboratory”,

reinforced the agency.

who can use

Also according to the folder, PrEP is indicated for anyone in a situation of vulnerability to HIV. Some situations that may indicate use are: the individual often stops using condoms during sexual intercourse (anal or vaginal); the individual makes repeated use of post-exposure prophylaxis (PEP); the individual has a history of episodes of sexually transmitted infections (STIs).

Also candidates for PrEP are individuals inserted in contexts of sexual relations in exchange for money, valuables, drugs and housing; individuals who engage in chemsex (sex under the influence of psychoactive drugs such as methamphetamines, GHB, cocaine, and poppers) in order to enhance and facilitate sexual experiences.

Access

The ministry’s guidance is that those interested in accessing PrEP seek a health service and find out if there is an indication. The list of services that offer pre-exposure prophylaxis can be accessed on the Ministry of Health website.

Protection

Women, transgender or non-binary people assigned female at birth, and anyone taking estradiol-based hormones who take daily oral PrEP should take the drug for at least seven days to achieve optimal levels of protection. Before the initial seven days of introducing PrEP, additional preventive measures must be adopted.

Men, non-binary people assigned male at birth and transvestites, and transgender women – who are not using estradiol-based hormones – and who use PrEP, either daily or on-demand, should take a dose of two pills of two to 24 hours before intercourse to achieve protective drug levels in the body for anal intercourse.

“Regular testing is essential, investigating signs and symptoms for other STIs. PrEP prevents HIV and allows the diagnosis and treatment of other STIs, interrupting the chain of transmission. The use of condoms prevents HIV and other STIs”,

alert the ministry.

Analysis

For the general coordinator of the non-governmental organization GTP+, Wladimir Cardoso Reis, PrEP facilitates prevention among few options.

“We only had condoms as a strategy. Therefore, PrEP is being welcomed. We have noticed this among straight and bi couples, transvestites, transsexuals and gays”,

he said.

The entity, headquartered in Recife, works for preventive, citizen and democratic education and health, transforming the reality of people living with HIV. In its 20 years of existence, the NGO has served more than 42,000 people.

One of GTP+’s main projects, Mercadores de Ilusões, trains sex workers as multiplying agents. Among the themes discussed in the streets of the capital of Pernambuco is precisely PrEP.

Regarding the new injectable drug approved by Anvisa, the general coordinator assesses that the antiretroviral, once incorporated into the SUS, should facilitate people’s access and adherence to PrEP, since, for example, there will be no need to commute daily for taking the medicine.

“This is an important moment for us to disclose this to populations with less social conditions and to have services that serve these populations and make PrEP available. After all, you will already be protected even before having sexual intercourse. It makes it very easy”.

“The whole country needs to be mobilized, this needs to be publicized more and more. Disseminate among peers, among people. Talking about sex is still something very conservative in our country. The more publicized PrEP is, the healthier and more present it will be in the sexual life of the Brazilian people”,

he said.

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