ARG breaks down HIV PrEP

The panelists answering questions from the participants during the open forum on 05 August 2022.

In partnership with various HIV/AIDS treatment hubs, the Research Institute for Tropical Medicine (RITM) AIDS Research Group (ARG) conducted the 2nd installment of the ARG Collaborative Conversations series on pre-exposure prophylaxis (PrEP) via Zoom and Facebook Live on August 5, 2022.

The event featured HIV physicians and experts as panelists which comprised Dr. Jan Dio Miguel Dela Cruz (LoveYourself, Inc.), Dr. Donna Catherine Ortiz (Laguna Medical Center), Dr. Jonah Adtoon (RITM), and Dr. Ronchie Santos (Bulacan Medical Center). The episode was hosted and moderated by RITM ARG physicians Dr. Jeffrey Garcia and Dr. Reuben Jamin Sales, respectively. Overall guidance for the online forum was provided by ARG Head Dr. Rossana Ditangco and ARG Clinic Head Dr. Mark Pasayan.

As of May 2022, a total of 1,308 cases have been recorded in the HIV/AIDS Registry of the Philippines. This records an average of 39 cases per day.

To combat the active increase of HIV/AIDS cases in the country, several strategies are implemented by healthcare providers. This includes PrEP which is a treatment provided for individuals before they come into contact with HIV. This can only be taken by individuals who have a negative HIV status.

PrEP initiation

Dr. Dela Cruz discussed how individuals can start PrEP. The treatment mostly benefits populations considered to be at high risk for HIV infection. It is recommended to be used on a daily basis and is effective for both men and women.

PrEP is an added layer of protection against HIV. PrEP does not prevent other STIs (sexually transmitted infections),” explained Dr. Dela Cruz.

Healthcare providers require HIV testing prior to starting or restarting PrEP. The test should yield a negative result. Other requirements may include screening for Hepatitis B and C, and syphilis, and kidney function tests. A medical consultation should also be conducted for further assessment of clients.

Kailangan niya ring dumaan sa counseling and medical consultation kasi uungkatin or bubusisiin ng ating healthcare provider kung mayroon siyang signs or history of an acute viral syndrome,” emphasized Dr. Dela Cruz on the importance of counseling and medical consultation prior to PrEP initiation.

(It is imperative that the client undergo counseling and medical consultation because the healthcare provider will assess and examine him/her for signs or history of an acute viral syndrome.)

PrEP intake

Dr. Ortiz explained that PrEP can be administered for daily or event-driven use. Daily PrEP is used by individuals engaging in frequent or unplanned sex. Otherwise, event-driven use is recommended. But as studies reveal, event-driven PrEP is only advisable for men having sex with men (MSM) and purely anal sex.

Studies also suggest that daily PreP is proven to be 99% effective. Despite this, PrEP should not serve as stand-alone treatment against HIV, but rather combined with other preventive strategies such as condoms, lubricants, and regular STI screening. Moreover, those taking PrEP should regularly consult with their healthcare providers for guided use.

“Dapat talaga maayos ‘yung counseling natin kasi ang labanan natin dito is medication adherence. Baka sinabi ng client natin, naka-PrEP siya pero hindi naman pala regularly, or mali-mali ‘yung way ng pag-inom niya so balewala lang din,” said  Dr. Ortiz, encouraging healthcare providers to exert efforts on good counseling practices for their patients.

(We really need to implement good counseling because medication adherence is a concern. Our clients may tell us that they are on PrEP, but they may not be taking it regularly, or even consume it incorrectly, which just puts the effort to waste.)

“We are just giving them false protection kung mali naman ‘yung adherence na ginagawa nila (if their adherence is incorrect),” added Dr. Ortiz.

PrEP for pregnancy and Hepatitis B

Dr. Adtoon highlighted that individuals with Hepatitis B infection may engage in PrEP provided that there will be regular follow-up consultations with HIV physicians before, during, and after PrEP.

Transmission of HIV and Hepatitis B infections is similar, which is why Dr. Adtoon notes that HIV patients should also be screened for Hepatitis B. The World Health Organization (WHO) recommends that those patients with positive HBV surface antigen test (HbsAg) results be further assessed for HBV treatment eligibility as not all individuals with chronic HBV infection require treatment.

Tenofovir, a medication given to HIV patients, is also the same treatment for Hepatitis B infection. 

Ang (the) treatment ng Hepatitis B is Tenofovir also. The Tenofovir that is active against Hepatitis B infection is given the same dose as that of PrEP,” said Dr. Adtoon.

As for women, studies show that they have an increased risk of acquiring HIV infection during pregnancy until at least six (6) months after postpartum. This is due to women’s biological susceptibility and behavioral exposure to HIV infection. Dr. Adtoon explained that PrEP is safe for pregnant women and even for women engaged in breastfeeding.

Halting PrEP for pregnant women requires assessment of their “seasons of risk”, or the current factors that may heighten their risk for HIV infection.

“Our HIV risk is never constant. Hindi po ito permanente. Pwedeng pwede po itong magbago depende sa sitwasyon. Kung kaya’t every follow-up [consultation], kailangan nating i-assess ang risk ng ating mga pasyente,” said Dr. Adtoon, reminding healthcare providers to assess the seasons of risk of their patients.

(Our HIV risk is never constant. This is not permanent. This can change depending on the situation. Which is why during every follow-up consultation, we need to assess the risk of our patients.)

PrEP maintenance and lifestyle

Dr. Santos underscored the value of proper PrEP storage. He also cascaded tips on how to incorporate PrEP in one’s routine.

PrEP should be stored in room temperature, and be stored with a dessicant to keep it dry. Dr. Santos recommends to have PrEP pills removed from the original bottle and transferred in other containers such as seven-day pill box. This is to avoid stigma against those individuals taking PrEP.

Dr. Santos also suggests that PrEP be taken at the same time as a regular activity such as eating breakfast and watching television. In addition, it is advisable to have clients set alarms or reminders for PrEP intake, ask trusted individuals to remind them, and to always bring an extra pill with them.

For patients taking PrEP daily, Dr. Santos recommends clients to plan their next clinic with at least seven (7) pills at hand just in case they miss an appointment with their physician. Should they run out of PrEP pills, clients should ensure that they observe other preventive strategies such as condoms.

Everything is behavioral. Lalo na para sa mga kaka-enroll pa lang na clients natin [sa PrEP]. Dahil ito ay bago pa lamang sa kanila, hindi pa ito naiincorporate sa [kanilang] routine,” said Dr. Santos.  

Lastly, Dr. Santos called on focusing more on advertising PrEP as protection to combat stigma and discrimination against vulnerable populations.

“Maaaring tama ang ating mga information na binibigay kay client, pero how we deliver it, maaaring magkaroon ng positibong pagtanggap sa kanya, o maaari naman ding negatibong pagtanggap sa pananaw niya sa PrEP na nagiging rason sa pagbaba rin ng ating enrollment on PrEP,” explained Dr. Santos on the significance of properly discussing PrEP to patients.

(We may be giving the right information to a client, but the way we deliver it may have a positive or negative impact on the client’s view on PrEP, which in turn becomes a reason for the decrease in enrollment for PrEP.)

Watch the 2nd episode of the ARG Collaborative Conversations here.

by Anel Azel Dimaano