Skip to main content
Pre-exposure prophylaxis (PrEP) reduces the risk of acquiring HIV when taken on the agreed schedule. It is a preventive medicine, prescribed only after checks that rule out an existing infection.

​
What is HIV PrEP?

PrEP is considered for people who want to reduce their risk of acquiring HIV. Before starting, HIV infection must be excluded and kidney function checked; follow-up includes regular testing and wider sexual-health care.

​
How PrEP works

The standard oral PrEP combination pairs emtricitabine (FTC), a nucleoside reverse-transcriptase inhibitor, with a tenofovir prodrug. Both must be phosphorylated intracellularly to their active forms — emtricitabine triphosphate and tenofovir diphosphate — which compete with natural nucleotides for incorporation by HIV-1 reverse transcriptase, causing chain termination. Two tenofovir prodrugs are authorised: tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF). TAF achieves higher intracellular concentrations of the active diphosphate in peripheral blood mononuclear cells at a lower plasma tenofovir exposure, which partly explains its improved renal and bone safety profile. TDF is taken up by proximal tubular cells via organic anion transporter 1 (OAT1); intracellular accumulation there can cause mitochondrial toxicity and proximal tubular dysfunction, which is why kidney function — specifically estimated glomerular filtration rate and urine protein — must be checked before and during treatment.

​
What the trials showed

The landmark iPrEx trial (Grant et al., NEJM 2010; PMID 21091279) was a randomised, double-blind, placebo-controlled trial that assigned 2,499 HIV-seronegative men and transgender women who have sex with men to daily oral FTC-TDF or placebo. Over 3,324 person-years of follow-up, FTC-TDF reduced HIV incidence by 44% (95% CI 15–63; P=0.005). Detectable blood levels of the study medicines correlated strongly with protection: the medicines were detected in only 9% of seroconverters versus 51% of matched controls who remained HIV-negative. The trial did not enrol cisgender women or people who inject drugs. The DISCOVER trial (Mayer et al., Lancet 2020; PMID 32711800) was a phase 3, randomised, double-blind, active-controlled, non-inferiority trial at 94 sites in Europe and North America. It randomised 5,387 adult cisgender men and transgender women who have sex with men 1:1 to daily FTC/TAF (200/25 mg) or FTC/TDF (200/300 mg). At the primary analysis after 8,756 person-years, FTC/TAF was non-inferior to FTC/TDF (incidence rate ratio 0.47, 95% CI 0.19–1.15). FTC/TAF was superior on all six prespecified bone mineral density and renal biomarker safety endpoints. Neither trial was designed to measure effectiveness in cisgender women, and both confirmed that PrEP does not protect against other sexually transmitted infections.

​
Why HIV must be excluded before starting

Starting PrEP in a person with undiagnosed HIV creates a functional monotherapy with only two agents, which can select for drug-resistant virus. That is why the reviewing doctor must confirm a negative fourth-generation HIV test (combined antigen/antibody) before issuing a prescription.
PrEP does not protect against other sexually transmitted infections, and it is not appropriate for someone who already has HIV — that is exactly why HIV status is checked before it is prescribed.

​
Your path to treatment

1

Start your online visit

Answer a questionnaire about your health and goal. No in-person appointment, no travel. You will know within 24 hours if you are a candidate.
2

A doctor reviews your case

A licensed doctor reviews your answers personally. If they need clarifications, they message you in the private chat on your account. If treatment is appropriate, they sign an electronic prescription.
3

Review and payment

If the doctor does not approve treatment, the consultation fee is refunded in full within 48 hours.
4

Ongoing support

Private chat with your doctor for questions, a check-in, and renewal before your prescription expires.

​
What the doctor checks

The reviewing doctor excludes existing HIV infection and checks kidney function before considering PrEP, since both directly affect whether it is safe and appropriate to start. Which specific medicine, if any, is right for you is a decision the doctor makes case by case after that review — this page does not list a dose or brand because that decision is diagnosis-led, not a menu choice.

​
How Hi-Doctor handles it

Licensed EU doctors

Prescription in under 24 hours

Secure patient account

Follow-up includes regular testing and wider sexual-health care, alongside the ongoing checks the doctor sets for your case.

​
Common questions

Through a questionnaire and doctor-review process: you answer questions about your health, sexual activity and medical history, and a licensed doctor reviews the case personally. The reviewing doctor must exclude existing HIV infection and check kidney function before considering PrEP.
HIV infection must be excluded and kidney function checked before starting. Follow-up includes regular testing and wider sexual-health care, alongside the ongoing checks the doctor sets for your case.
Yes. The same consultation and doctor-review standard apply wherever you are in the EU; there is no separate process for a particular country.
Yes. Your consultation, answers and medical records are held in a secure patient account and are not shared without your consent.
A licensed doctor reviews your questionnaire and, if appropriate, issues an electronic prescription valid across the EU. Hi-Doctor does not sell or ship medications — any prescribed medicine is dispensed by the pharmacy you choose.
PrEP reduces the risk of acquiring HIV when taken on the agreed schedule. HIV infection must be excluded and kidney function checked before starting; follow-up includes regular testing and wider sexual-health care.
Related: doxycycline and azithromycin, antibiotics reviewed as part of the same sexual-health consultation pathway. See also safety and eligibility checks, how the consultation works and pricing.

​
Start a consultation

Sexual health consultation

Answer the sexual health questionnaire and a registered doctor reviews it. They decide whether treatment is appropriate, which one, and at what dose — and declining is a normal outcome. See what it costs and how the review works.
This page is reference information, not medical advice and not a prescription. Whether a medicine is appropriate for you is decided by a registered doctor after reviewing your consultation.