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PrEP

Pre-Exposure Prophylaxis

In the case of PrEP, the HIV medication is taken before a possible risk contact. The medication requires a prescription.

 

The costs will be reimbursed by the public health insurances since 01.04.2024.

—> Attention: does not apply to the KfA!

 

So far, only one drug has been approved for this specific purpose in Europe – at a monthly cost of almost 1000 euros per month. However, since the patent protection has expired, there are more and more generic drugs (drugs that contain the same active ingredient as the original) that are available at significantly lower prices. Even these still cost several hundred euros a month if they are used to treat an HIV infection.
However, some pharmacies offer the medication for just under 60 euros per month thanks to special contracts with the manufacturers.

As already mentioned, generics with the active ingredient combination tenofovir disoproxil and emtricitabine are used for PrEP. These are intended to prevent the HI virus from multiplying in the body.
The first study on this was the PROUD study with 544 gay men. It showed that the probability of becoming infected with HIV was reduced by 86% when taking PrEP. Further studies were the IPERGAY study, which was conducted on event-related PrEP, and the French PREVENIR study with over 3,000 participants who were able to decide for themselves whether to take PrEP on an event-related or daily basis. When the results were presented in July 2019, it was shown that there were only two HIV infections among the 3,000 participants.


There are two different ways of taking PrEP, although only continuous (daily) use is officially approved by the health authorities.


1) continuous, daily intake:

  • once a day 1 tablet
  • has the advantage that you don’t have to plan your sexual intercourse
  • is recommended if you have sexual intercourse once a week or more often
  • If you want to have sexual intercourse shortly after starting PrEP, you should take 2 tablets on the first day at least 2 hours before the first contact. Otherwise, you must have taken one tablet a day for a week before your first sexual intercourse.
  • If you want to stop taking daily PrEP, you should continue to take it for 7 days after your last sexual intercourse.
  • Due to a different distribution at the site of action, only daily use starting 7 days before sexual intercourse is safe in the case of vaginal intercourse. On-demand PrEP is not suitable in this case!

2) Occasion-related PrEP (there is no official approval for this dosage regimen):

  • Take 2 tablets at once at least 2 to a maximum of 24 hours before sexual intercourse
    • on the following days (every 24 hours) take one tablet everyday
    • 24 and 48 hours after the last sexual intercourse  take one more tablet each – only stop after this 2 days
  • only appropriate if you rarely have a potential HIV risk contact and sexual intercourse can be planned in advance
  • not possible if you have chronic hepatitis B!
  • not suitable for vaginal intercourse

It should be noted that the on-demand PrEP has no official approval. However, its effectiveness has been demonstrated in studies.

Like PEP, PrEP is suitable for minimizing the risk of HIV infection – but does not prevent the transmission of all other sexually transmitted diseases (STIs). Only a condom protects against all other sexually transmitted diseases such as syphilis, gonorrhea, chlamydia and hepatitis A and C.


A medical consultation must be held before taking PrEP.
Our patients only pay €25 for the consultation (reimbursement by the health insurance is planned from 01.04.2024). PrEP and how to take it will be discussed in detail and the necessary laboratory tests will be carried out. You will then receive a corresponding prescription from us, which you can only redeem in special pharmacies.
From 01.04.2024, the costs for the medication are expected to be reimbursed by the health insurance – up to a maximum amount of €60 per pack.

We nevertheless offer PrEP advice to patients who do not switch to us and are therefore affiliated with another GP.
Please note, however, that we will then charge an additional fee of €75 per quarter. This covers all PrEP consultations and any necessary STD treatments.
Please also note that you will then have to contact your family doctor for all issues not related to PrEP or STDs.


Adequate vaccination against hepatitis B is a mandatory requirement for taking PrEP, as an infection while taking PrEP can otherwise lead to permanent damage.

Therefore, please bring your vaccination certificate to the first appointment!

If no vaccination is documented, the vaccination status can be determined for €10,- as part of the blood test.

If you have not had a hepatitis B vaccination, a basic immunization (consisting of 3 injections) is necessary.
If the last booster vaccination was more than 10 years ago, a single booster is required.

Alternatively, the hepatitis B vaccination can also be combined with a vaccination against hepatitis A. The costs for the vaccines are as follows:

– Hepatitis B only = 47,-€
– Hepatitis A&B = 98,-€


Cost overview:

– PrEP consultation: €25 once per quarter (reimbursement by health insurance planned from 01.04.2024)

– Basic service: € 75,- once per quarter (only for patients who are not our patients and therefore visit us privately – no reimbursement (!), includes PrEP care and any necessary STD treatments)

 

—> Further information on how the reimbursement works can be found HERE.