Since the start of the HIV pandemic, the world has gone a long way to slow down and even prevent the spread of the virus. Several scientific and medical accomplishments have made that possible, raising hopes of complete HIV eradication by 2030.
Single Dose, On-Demand and Injectable PrEP
HIV PrEP or pre-exposure prophylaxis is a combination of medications administered to prevent the risk of contracting HIV through unprotected exposure. Undoubtedly, this is the biggest breakthrough as far as prevention among high risk groups goes.
The traditional antiretroviral drugs that PrEP consists of have to be taken according to a schedule for a certain period of time. This type of HIV prevention received FDA approval in the US in 2012. Over the same year, the World Health Organization (WHO) issued its guidelines and recommendations for the administration of PrEP among high risk groups.
The effectiveness of PrEP, however, is heavily dependent on adherence to the schedule. If a person is not diligent enough, the risk of contracting HIV increases.
This is the reason why the medical community has started experimenting with single dose and on-demand PrEP medications.
On-demand PrEP follows a different schedule to the traditional form of the medication. It’s called on-demand, as it is used to address a specific event. The schedule is also a lot simpler – two tablets have to be taken 24 hours before intercourse, one tablet is taken 24 hours later and there’s a final one taken 24 hours after the third tablet.
In total, on-demand PrEP consists of four tablets, which makes it different from the daily dose of traditional medications that at-risk individuals have to take every single day.
Most countries have already adopted fairly simple procedures for the administration of on-demand PrEP. The effectiveness of this reduced dose medication has also been established as excellent.
Injectable PrEP is the second innovative form of the medication that deserves some recognition. This is a single dose administration that eliminates all of the scheduling complications of the above-mentioned prevention options.
The effectiveness of injectable PrEP has been studied and research suggests that it is as effective as the most common form of traditional PrEP – Truvada.
Dosage reduction or the administration of a single injection may seem like small changes but in fact, they can contribute to a huge positive result. Human error can still be blamed for reduced effectiveness of HIV prevention medications. When the risk of forgetting a dose is eliminated, the effectiveness of PrEP can be anticipated to skyrocket even further.
The second crucial HIV prevention breakthrough is the development of a vaginal ring for at-risk women. This form of medication administration is especially important for administration in regions like Sub-Saharan Africa where women of reproductive age are at a particularly high risk of becoming infected.
The dapivirine vaginal ring (DPV-VR) is a long-lasting solution that has once again been developed to eliminate the need for a daily dose of an antiretroviral drug.
DPV-VR has already received positive European Medicine Agency reviews. The ingenious medical device works in two ways – it acts as a contraceptive and it also releases sufficient doses of antiretroviral medications to reduce the likelihood of contracting HIV through exposure.
According to preliminary clinical trials, the correct use of the vaginal ring reduces the risk of HIV infection by as much as 50 per cent. Needless to say, this effectiveness is limited in comparison to what daily PrEP can accomplish. Still, the ring gives women an option and more control over their reproductive health. As the development is still ongoing, the effectiveness of the ring could be anticipated to increase even more in the years to come.
DPV-VR is not ready for mass production yet. Research into the creation of such a product, however, solidifies once again the need for effective single dose PrEP administration. Such a method of drug delivery could prove to be life-saving in parts of the world where people do not have ready, everyday access to reproductive health clinics.
The Biggest Achievement of Them All: Reliable Testing
This may seem like the simplest and least advanced of all the HIV prevention breakthroughs but it is probably the most important one.
Effortless, readily accessible, affordable and accurate HIV testing is the one option that has contributed to the significant slowdown of the pandemic since its early days.
The first-generation lab antibody tests for HIV was introduced in 1987 and not surprisingly, it was known for a big number of false negative tests (especially among individuals in the early stages of the acute infection).
Today, we are using the fourth generation of laboratory tests that use antibody detection alongside p24 antigen detection. The levels of p24 antigen start increasing very soon after an active infection, which means that earlier detection of the virus is now possible. Research suggests that fourth generation HIV tests are 99.1 per cent effective in comparison to an effectiveness of 92 per cent for first generation tests.
In Singapore, HIV testing, HIV PEP and PrEP are readily available. Reproductive health facilities like Shim Clinic make such services accessible in a respectful, fully confidential manner.
Anyone who is sexually active should consider getting tested for HIV regularly. Going through STD testing at least once or twice per year will give you peace of mind and confidence in knowing your status. If you belong to a high risk group, a test every couple of months would be optimal.
For more information, please contact Shim Clinic or visit our facilities during working hours every day of the week.