Nederlands
Introduction
This PrEPnu protocol is based on the official Dutch PrEP Guideline from organizations such as the Dutch Association of HIV Practitioners and the expert group on STI, HIV, and Sexuality for general practitioners. It is advisable to adhere to this (more comprehensive) guideline, preferably with the assistance of your general practitioner. Therefore, we recommend that you bring the printed official Dutch PrEP guideline to your appointment with your GP, open to the table on page 12. This table summarizes how to safely use PrEP and which tests are necessary before starting PrEP.
PrEP is an extremely effective preventive measure against HIV. This has been scientifically proven. However, the use of PrEP does not provide a 100 percent guarantee. (This applies to all preventive measures, including condoms.)
Medical tests that need to be done for PrEP users:
(Underlined items are crucial to prevent significant health risks, other items are of lesser importance, but we still recommend them to you.)
Prior to starting PrEP:
✯ Kidney function test + urine dipstick test for protein and glucose in urine
‣ PrEP is not suitable for individuals with impaired kidney function. This should be ruled out before starting PrEP through a kidney function test. You can request this test from your general practitioner, and soon, we expect the GGD Amsterdam to offer this test for free. It involves determining your creatinine level in your blood, and your GP can also conduct a test for protein and glucose in your urine. These are not costly tests and will not have a significant impact on your own risk.
✯ Hepatitis B Virus test
‣ This test is to ensure you do not have an active hepatitis B infection. Even if you have been fully vaccinated against hepatitis B, it is essential to perform this test through your general practitioner. Vaccination is not always 100% effective, and there is a risk of getting sick if you have unknowingly contracted hepatitis B and then start using PrEP.
‣ The hepatitis B test is not necessary if you can prove with a past antibody test that you are truly immune to hepatitis B. Once immune to hepatitis B, you are always immune to hepatitis B. Proof of vaccination alone is NOT sufficient.
✯ HIV test (4th generation HIV combination test) + Screening for other STIs: chlamydia, gonorrhea, syphilis in the throat, anus, and urine
‣ It is crucial that before starting PrEP, you do not have HIV; otherwise, the HIV virus can become resistant to the active ingredients in PrEP. Therefore, you must have an HIV test conducted through your general practitioner or at the GGD shortly before starting PrEP (up to 2 weeks before). This should be a 4th generation HIV test, and the result may take a few days. If you get tested through your GP or at the GGD (e.g., via mantotman.nl), you will automatically receive this new HIV test. An HIV rapid test, where you get the result immediately, often through a finger prick, is NOT sufficient.
✯ Get tested for STIs every 3 months
‣ We strongly recommend that you get tested for STIs, including HIV and hepatitis C, before starting PrEP and every three months thereafter. Hepatitis C was found to be relatively common among people who participated in the AMPrEP study. Therefore, we advise you to get tested for hepatitis C antibodies through your general practitioner.
‣ Please note: getting an HIV and STI test through your general practitioner can easily contribute to your own risk excess (out-of-pocket expenses). To keep costs low, you can have the HIV and STI test done at the GGD or through Testlab van Man tot Man, and the other tests through your general practitioner. Hepatitis B and C are not automatically tested by the GGD.
✯ Check for drug interactions with medications you are already using
‣ PrEP can interact with certain other medications (e.g., valacyclovir, a medication for herpes). It is essential that if you are already taking medication, you check whether they interact with PrEP before starting it.
‣ Consult with your general practitioner or pharmacist and use hivdruginteractions.org as a resource. Input “Tenofovir-DF” and “Emtricitabine (FTC)” under HIV Drugs, and enter the names of the medications you are using (the generic names, not brand names, refer to the package insert for this). You will receive information on whether there are any interactions with these drugs.
‣ Once you have started with PrEP and you receive new medications, check again with your doctor or pharmacist to ensure there are no new interactions with PrEP and discuss with your doctor that you are using PrEP.
1 month after starting PrEP: ✯ Kidney function test
‣ In rare cases, PrEP can cause a disruption of kidney function. Therefore, it is important to have your kidney function checked again 1 month after starting PrEP.
✯ HIV combination test (4th generation ELISA); see above
Every 3 months after starting PrEP:
✯ HIV combination test (4th generation ELISA); see above ✯ STI screening: chlamydia, gonorrhea, syphilis in the throat, anus, and urine ✯ Hepatitis C antibodies test
Every 6 months after starting PrEP:
✯ Kidney function test + urine dipstick for protein and glucose in urine ✯ Hepatitis C antibodies test
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