PrEP should not be used if you are HIV positive.
You may not need PrEP if you are:
- using condoms consistently and happy to continue using them
- only having sex with HIV-positive partners who are on treatment and have an undetectable viral load
An undetectable viral load is when the virus exists in such small amounts that it can’t be detected by standard blood tests. It means the level of HIV in your body is so low, it can’t be passed on. This needs to be monitored regularly by a healthcare professional.
Tests you need before you start PrEP
If you decide to start taking PrEP, there are a few tests that you will need first.
You must have a 4th generation HIV test before or as you start PrEP. A blood sample will be taken, usually from your arm, and sent to a laboratory. This test has a window period of around 4 weeks.
The window period is the time between when you may have been exposed to HIV, and the point when the test will give an accurate result. During the window period you can be infected with HIV but still have a negative HIV test.
If there is a chance that you have been exposed to HIV in the last 4 weeks, tell your healthcare provider. You may need more blood tests and a repeat HIV test 4 weeks after starting. This is to make sure that an early infection is not missed.
If you have had a recent HIV risk and have developed flu-like symptoms, this may be a sign of HIV seroconversion. This is when the immune system produces antibodies in response to a recent HIV infection. In this situation it may not be safe to start PrEP until the result of your HIV test is back from the laboratory and HIV has been ruled out.
If you are starting PrEP after PEP, it is best to start immediately after you finish the course of PEP. There is no need to delay starting PrEP after PEP. Ideally you should have a 4th generation HIV blood test around the time you finish PEP/start PrEP. You should have another HIV blood test 4 weeks after starting PrEP.
Sometimes a rapid HIV test is done in addition to the laboratory HIV test. If the rapid test is negative it may be possible to start PrEP on the day you are first seen regarding PrEP. This will be discussed with you in greater detail by your healthcare provider.
Hepatitis B test
You must have a test for hepatitis B. This is because PrEP medicines are active against both HIV and hepatitis B. Taking PrEP if you have undiagnosed Hepatitis B could be harmful to you.
You can still use PrEP if you have hepatitis B, but it needs to be used more carefully.
If you have hepatitis B, you need to take daily PrEP with medical advice and monitoring, especially if you want to stop. Event based dosing (EBD) is not suitable if you have hepatitis B or if you don’t know your hepatitis B status.
This is a good time to be vaccinated, or to boost a previous vaccine.
Hepatitis A and B vaccination is recommended for gay, bisexual and other men who have sex with men (MSM) and people who inject drugs (PWID).
Kidney monitoring involves a blood test for creatinine, and sometimes a urine test for protein. These should ideally be done just before or on the day you start PrEP.
Sexually transmitted infections (STIs) tests
You should have STI testing, which includes testing for:
- hepatitis C
HPV vaccination is recommended for gay, bisexual and other men who have sex with men (MSM) up to 45 years of age. HPV vaccination protects against genital warts and HPV-associated cancers.
If there is a chance that you may be pregnant you should have a pregnancy test before starting PrEP.