Thanks to medical research and development, the HIV infection in Switzerland has changed from a deadly to a chronic, well-controlled disease. However, this requires the lifelong intake of treatment. Instead of opportunistic infections that formerly shaped the image of the disease, HIV today is associated with an increased risk of heart attack or dementia and the control of side effects related to treatment. Thanks to a bundle of measures started early in Switzerland, the epidemic could be rapidly controlled in this country. Unfortunately, every year, about 300-400 new HIV infections still are diagnosed in Switzerland. Half of them are diagnosed among men who have sex with men. Other infectious diseases such as gonorrhea or syphilis are rising in recent years.
What is PrEP?
Prep is a medical prophylaxis with drugs originally developed for HIV therapy. The effectiveness of the combination of the two active ingredients Tenofovir and Emtricitabine (TDF / FTC) as Prep was shown in several large studies. In Switzerland, TDF / FTC is currently approved as PreP, but. The costs of the drugs must be beard by the user himself. To avoid drug side effects and emergence of resistances, it is important to take PrEP under medical supervision.
How well does PrEP protects against HIV?
The effectiveness depends strongly on the correct use of the drugs. If these are taken daily or correctly event-driven, protection is likely to be comparable to condoms. The effectiveness decreases when the drugs are taken only irregularly. A few cases are known whereby a HIV infection occurred despite the correct use of PrEP.
What kind of risks are associated with PreP?
The two medications tenofovir and emtricitabine are known in HIV therapy for years. With this combination, kidney, liver and bone damage may occur. Therefore, this medication may not be taken with a pre-existing disease to these organs, and it also requires regular blood controls in order to avoid side-effects to the organs. If PreP was taken while a person has already been infected with HIV, it can lead to emergence of resistance to TDF/FTC because this combination does not confer full activity to treat a HIV infection. PrEP may also not be taken with an acute hepatitis B infection, as an aggravation of the hepatitis B infection can occur after discontinuation of PreP. In addition, PreP protects against HIV but not against other sexually transmitted diseases and regular STI test have to be performed on PreP.
Who pays PreP?
HIV drugs for people who have no HIV infection are not paid by the health insurance in Switzerland. The consultations including STI testing are covered by health insurance in most cases. However, PrEP medication will not be covered and costs are therefore out of pocket. Today, one bottle TDF/FTC for one month is available for 45 CHF.
Who should take PreP?
PrEP is aimed at people who have an increased risk to contract HIV and who do not consistently protect themselves with condoms. In Switzerland, these are primarily homosexual and bisexual men who have changing sexual partners and who have problems using condoms.