What's the difference between PEP and PrEP?
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As indicated by 'post', you start to take it after a single event that may have exposed you to HIV. PrEP is designed to be used in a planned way.
Dr.Deyn Natthakhet Yaemim, written on 28 Janruary 2019. Last reviewed 24 August 2022
What's the Difference Between PEP and PrEP?
PrEP and PEP are two ways to use anti-HIV medications as ‘prophylaxis’, in other words as prevention. They work in different ways.
PrEP stands for pre-exposure prophylaxis. It is for people who don’t already have HIV but are at very high risk of getting it. PrEP is daily medicine that can reduce this risk. With PrEP, if you do get exposed to HIV, the medicine can stop HIV from taking hold and spreading throughout your body.
PEP stands for post-exposure prophylaxis. HIV PEP is for people who have possibly been exposed to HIV. It is only for emergency situations. PEP must be started within 72 hours after a possible exposure to HIV.
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PrEP vs PEP
| PrEP (pre-exposure prophylaxis) | PEP (post-exposure prophylaxis) | |
| What does it mean? | As indicated by ‘pre’, you start to take it before you may be exposed to HIV. | As indicated by ‘post’, you start to take it after a single event that may have exposed you to HIV. |
| What is it for? | PrEP is designed to be used in a planned way, on an ongoing basis. | PEP is used in emergency situations. |
| How to take it | Most people take PrEP once a day, every day. Some people can use ‘event-based’ dosing, which involves taking it before sex and then for two days afterwards. | PEP is a four-week course of drugs, taken once a day during that time. It is best to start PEP within 24 hours of exposure to HIV, but certainly within 72 hours. |
| What is inside? | There are two drugs in PrEP. They are usually combined in a single tablet. | There are three drugs in PEP – usually the same two that are taken for PrEP, plus a third one. The third drug works in a different way to the first two (it from a different drug class). The three drugs are usually provided in two tablets. |
| Who is it for? |
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| Who should take it? | Gay/bisexual men who:
Heterosexual men and women who:
People who inject drugs and:
| For HIV prevention after you may have exposed to the virus:
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| Effectiveness | Daily PrEP can reduce the risk of HIV transmission from sex by 99% when taken correctly. | When taken correctly, PEP can reduce the risk of HIV transmission by almost 80% It’s still important to use condoms, other barrier methods, and cautious injection practices |
If you are taking PEP now and you think you might need protection again in the coming weeks and months, you can talk to your doctors about switching to PrEP at the end of the course.
And if you have needed PEP sometime in the past, especially if you’ve needed it more than once, it’s worth thinking about whether PrEP might be a good option for you going forward.
How to Take PEP
You must initiate PEP (post-exposure prophylaxis) within 72 hours of a potential HIV exposure, although starting within 2 hours to 24 hours is ideal. Then you need to take the medications every day for a full 28 days. Most PEP regimens require taking pills every single day, exactly as prescribed. Do not skip doses.
How to Take PrEP
The Clinical Practice Guideline of the United States (2013) and HIV prevention Guidelines of Thailand (2014) have some really good info that suggests taking daily oral PrEP to lower your risk of getting HIV. Our advice on PrEP is based on two European studies. These studies looked at different ways to take the treatment. Both of them showed that taking PrEP every day reduced your chances of catching HIV by 86%.
PROUD Study1 DAILY DOSE
In this study, people took a TDF/FTC pill every day. No one who took the TDF/FTC correctly caught HIV in this study. This is the officially recommended way to take PrEP. A doctor would usually recommended this regimen
IPERGAY Study2 ON DEMAND
In this study, people took 2 TDF/FTC pills between 2 and 24 hours before sex. Then, they took one TDF/FTC pill every day until 2 days had passed after the last time they had sex without a condom. This regimen is not recommended for vaginal sex. (And it’s not recommended for gay people who enjoy chemsex or don’t plan to have sex very well because there’s evidence that many people forget to take the third and fourth pill.)
Using a 2-1-1 dosage timeline – two pills between 2 and 24 hours before sex, one pill 24 hours after the first pill, and a final pill 24 hours later – PrEP is shown to give you the same protection against HIV as taking it every day.
If you’re thinking about PrEP On Demand, it’s super important to take all your doses on time. If you’re worried about missing doses, chat with your doctor or counselor about switching to daily PrEP instead. PrEP On Demand only protects you from HIV exposure during anal sex. If you’re into activities like chem fun (CF), a daily PrEP course will be more effective in keeping you safe.
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PrEP: Which One is Right for You?
Currently, there are only a few types of PrEP medication available in the market. All of them serve the same purpose: to reduce the risk of contracting HIV. Each option is approximately 99% effective in preventing HIV when taken correctly. Consequently, the differences between these medications are minimal. Choosing the appropriate type of PrEP will ensure that you adhere to the prescribed regimen and maximize the benefits of the medication.
| Comparison | Origianl PrEP 2013 (Truvada) | New Oral PrEP 2019 (Descovy) | Injectable PrEP 2021 (Apretude) |
| Active ingredients | Tenofovir Disoproxil Fumarate + Emtricitabine | Tenofovir Alafenamide + Emtricitabine | Cabotegravir |
| How effective? | 99% effective against HIV when taken correctly | ||
| How to take it? | Oral medication | Injection to your muscle | |
| Who can take it? | Men or women who are at risk of HIV | Only men and transwomen who are at risk of HIV | Men or women who are at risk of HIV |
| How often to take it? | Daily dose or On Demand | Daily dose only | Once every 2 months after the intitial doses |
| Main benefits |
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How Much Does PrEP Cost?
Old version PrEP 2012 | ||||
| 1 Bottle (30 tablets) | 6 Bottles (180 tablets) | 12 Bottles (360 tablets) | ||
| HIV-PrEP Teno-Em |
| 1,250
| 10,500 | 13,900 |
| HIV-PrEP Tenof-Em |
| 1,100
| 9,300 | 13,900 |
New PrEP 2019 | ||||
| 1 Bottle (30 tablets) | 6 Bottles (180 tablets) | 12 Bottles (360 tablets) | ||
| HIV-PrEP Descovy® | 3,150
| 21,000 | 39,000 | |
HIV-PrEP |
| 1,640
| 12,000 | 21,000 |
| HIV-PrEP Taficita |
| 3,000
| ||
| HIV-PrEP Tafero-Em |  | 3,105 | ||
Injectable PrEP (NEW!) | ||||
| 3 Doses (5 months) | 5 Doses (9 months) | 7 Doses (13 months) | ||
| Injectable Apretude |  | 58,000 | 95,000 | 126,000 |
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