Are There Risks Associated With Non-Prescription PrEP Use?


PrEP isn’t covered by health insurance in Germany, and non-prescription use of the HIV preventive is common. But is it safe?

Before generic pre-exposure prophylaxis (PrEP) was made available for purchase in Germany with private prescriptions in 2017, non-prescription use of the HIV preventive was a common occurrence. Because PrEP, and the associated provider visits and HIV tests, are not covered by insurance in the country, informal use of PrEP was—and still is—occurring.

Investigators with the Robert Koch Institute in Berlin sought to explore just how common informal PrEP use still is among German PrEP users and whether there are risks associated with non-prescription use. They presented their findings recently in a poster session at the Annual Conference on Retroviruses and Opportunistic Infections (CROI 2019).

Investigators recruited 2005 current PrEP users via location-based dating apps frequented by men who have sex with men (MSM), community based HIV testing sites, and a community website in Germany to take an anonymous online survey. A total of 78.7% of participants completed the survey with a median age of 38 years (Interquartile Range (IQR): 31—45).

Most respondents (95.4%) reported having had a medical test before initiating PrEP, and 86.9% reported receiving medical tests while using PrEP.

Additionally, a majority of respondents (80.4%) had a prescription for PrEP, while 19.6% obtained the medication via non-prescription sources (ordering online 9.9%; buying drugs in another country 3.2%; through friends 2.8%; using medication from post-exposure prophylaxis as PrEP 1.0%; buying from dealers 0.8%; sex parties 0.8%; other sources 1.0%).

Interestingly, non-prescription PrEP users had been on the prevention treatment longer than prescription users (median: 7-12 months vs 3-6 months, p<0.001), but were more likely to use PrEP intermittently or on-demand (prior to an anticipated sexual encounter with an HIV-positive partner or partner of unknown status) (Odds Ratio (OR) = 4.4, 95% Confidence Interval (CI) 3.2, 5.9).

Non-prescription users were also more likely not to have obtained medical testing before initiating PrEP (OR = 8.1, 95% CI 4.5, 14.5) or during PrEP use (OR = 5.8, 95% CI 4.1, 8.3).

“Non-prescription PrEP users were less likely to use PrEP according to current guidelines,” the investigators concluded. “This could increase the risk for undetected HIV and STI infections in this group. Our findings highlight the need for patients to access PrEP through health care systems in order to allow safe use.”

The study, “Risk Factors Associated With Nonprescription Use of HIV Pre-exposure Prophylaxis,” was presented on Wednesday, March 6, 2019, at CROI 2019 in Seattle, Washington.

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