PrEP (HIV pre-exposure prophylaxis) is prescribed via online consultation.
Consultations are available daily from 9:00 to 22:00, with same-day shipping possible. Both daily and on-demand options can be discussed.
What is PrEP (HIV Pre-Exposure Prophylaxis)?
PrEP (Pre-Exposure Prophylaxis) is a prevention method where individuals who are not infected with HIV take anti-HIV drugs (generic name: tenofovir/emtricitabine combination drug) in advance to reduce the risk of infection. Studies report that correct adherence to PrEP significantly reduces the risk of HIV infection. However, PrEP does not prevent other sexually transmitted infections such as syphilis or chlamydia, so concurrent use of condoms and regular testing may be necessary. At Mona Aoyama Clinic, PrEP is prescribed after an online doctor's consultation and delivered to your home (private medical care).
PrEP (Pre-Exposure Prophylaxis) is a method that proactively establishes a state within the body where infection is unlikely to occur, even if exposed to the virus. While not widely known in Japan, the WHO (World Health Organization) has issued guidelines stating that PrEP options should be offered to individuals at high risk of HIV infection, and it is recognized globally as an HIV prevention method.
How effective is PrEP?
| Dosing Method | Reported Efficacy |
|---|---|
| Daily PrEP | When taken correctly every day, it is reported to reduce the risk of HIV infection through sexual activity by approximately 99%. |
| On-demand PrEP (2-1-1) | In clinical trials targeting men who have sex with men, the risk of infection was reported to decrease by 86%. |
Both figures apply when the medication is taken "as prescribed." Skipping doses or self-administering at different times significantly reduces efficacy. Individual results may vary.
What is HIV?
HIV (Human Immunodeficiency Virus) is a virus that infects CD4-positive lymphocytes (a type of white blood cell) responsible for the body's immune function, gradually weakening the immune system. Transmission primarily occurs through sexual activity (especially unprotected sex), blood (such as sharing needles), and from mother to child. Immediately after infection, symptoms are often absent or consist only of temporary, flu-like symptoms such as fever, fatigue, and swollen lymph nodes. It is common for several years to a decade to pass without noticeable symptoms.
What is AIDS?
If left untreated, immunity significantly declines, leading to the development of "AIDS," a state where opportunistic infections (infections caused by pathogens that normally wouldn't cause disease) and cancers occur. Thanks to advances in treatment, early detection and consistent, appropriate treatment allow individuals to live a life nearly identical to healthy people without developing AIDS.
Consider PrEP in these situations
The following situations indicate a higher risk of infection and are a general guide for who should consider PrEP. A doctor will determine suitability based on a medical interview.
- Frequent unprotected sexual activity
- Sexual activity with multiple partners
- Partner is HIV positive or their HIV status is unknown
- Uses injectable drugs or has a partner who uses them
- Has previously used PEP (post-exposure prophylaxis) and expects continued risk
For ongoing risks, preparation is more certain.
Daily PrEP vs. On-Demand PrEP
There are two types of PrEP: Daily PrEP and On-Demand PrEP. To prevent increased infection risk due to missed doses, we generally recommend Daily PrEP.
| Item | Daily PrEP | On-Demand PrEP (2-1-1) |
|---|---|---|
| Dosing Method | One tablet daily, at the same time | 2 tablets 2-24 hours before sexual activity, then 1 tablet every 24 hours thereafter |
| Target Audience | Efficacy confirmed regardless of gender or type of sexual activity | Only for men who have sex with men. Not recommended for those engaging in vaginal sex or using injectable drugs. |
| Benefits | Easy to remember dosing schedule / Can respond to unexpected sexual activity / May be used by individuals with chronic hepatitis B | Only take when sexual activity occurs / Can reduce costs |
| Best for | Individuals with continuously high infection risk / Those who find planned dosing difficult | Individuals with infrequent sexual activity / Those who can plan ahead / Those looking to reduce costs |
| Precautions | Requires daily continuous use | Must adhere to dosing timing / Cannot be used by individuals with hepatitis B |
How to take Daily PrEP
- Take one tablet daily, at approximately the same time each day. Deviations of a few hours are generally not a problem.
- Can be taken with or without food. If you experience stomach discomfort, taking it after a meal may help alleviate it.
The medication does not become effective immediately after starting. The time required to achieve sufficient protective effect varies depending on the type of sexual activity.
| Type of Risk | Estimated time to achieve sufficient effect |
|---|---|
| Anal sex | Approximately 7 days of consecutive daily use |
| Vaginal sex/Injectable drug use | Approximately 21 days of consecutive daily use |
During this period, we recommend using condoms.
How to take On-Demand PrEP (2-1-1)
Take a total of 4 tablets according to the following schedule, aligned with planned sexual activity:
| Timing | Dosage | Key Points |
|---|---|---|
| 2-24 hours before sexual activity | 2 tablets | The closer to 24 hours before, the higher the drug concentration in the body. Take at least 2 hours before. |
| 24 hours after the first 2 tablets | 1 tablet | Even if sexual activity has ended, be sure to take this dose. |
| 48 hours after the first 2 tablets | 1 tablet | This completes one course (total 4 tablets). |
If you have sexual activity for two or more consecutive days
This is where it is easiest to make a mistake. It's not "done after 4 tablets." If sexual activity continues the next day or later, you should continue taking 1 tablet daily until 48 hours have passed since your last sexual activity.
For example, if you have sexual activity on Friday and Saturday, continue taking 1 tablet daily after the 2 tablets on Friday, until two days after your last sexual activity on Saturday (Monday).
When resuming for the next occasion
- If it has been within 7 days since your last PrEP dose, you can resume with 1 tablet for the initial dose, not 2.
- If it has been more than 7 days, please start with 2 tablets as usual.
Who cannot use On-Demand PrEP
The on-demand (2-1-1) method is not suitable for everyone. Please consider Daily PrEP if you fall into any of the following categories:
- Individuals who engage in vaginal sex: It is known that drug concentrations in vaginal tissue may not reach sufficient levels, and efficacy has not been confirmed for this group.
- Individuals who use injectable drugs: There is no efficacy data for this method.
- Individuals infected with hepatitis B: The medication used for PrEP is also effective against the hepatitis B virus. Intermittent use or stopping the medication can worsen hepatitis.
- Individuals who find it difficult to adhere to dosing times.
If you miss a dose
For Daily PrEP: If you realize you missed a dose, take one tablet as soon as you remember, and then continue taking it at your regular time on subsequent days. There is no need to take two doses together. If you frequently miss doses, the preventive effect may be insufficient.
For On-Demand PrEP: If you miss taking the initial two tablets before sexual activity, take them as soon as possible and then continue with the subsequent schedule (one tablet each after 24 and 48 hours) as usual. However, if the timing deviates significantly from the prescribed schedule, the preventive effect may be insufficient. Please consult us if you are unsure.
How to take when stopping
When discontinuing PrEP, immediately stopping can create an unprotected period. Please continue taking the medication for the following period after your last risky sexual activity.
| Type of Risk | Duration of continuation after last risky activity |
|---|---|
| Anal sex | 7 days |
| Vaginal sex/Injectable drug use | 28 days |
If you are infected with hepatitis B, do not stop the medication on your own. Discontinuing the medication can worsen hepatitis, so please consult a doctor.
We also offer consultations on how to take the medication during your examination.
About Side Effects
Side effects of PrEP may include headaches, nausea, and abdominal bloating (occurring in approximately 2% of cases). Most of these are mild and usually subside within about a month. Effects on kidney function and bone density have been reported, so regular monitoring tests will be conducted. If symptoms are severe or concerning, please consult a doctor. The extent of effects and side effects varies among individuals.
Symptoms requiring attention
- Fever, fatigue, flu-like symptoms
- Jaundice (yellowing of skin or whites of eyes)
- Dark urine, pain in the upper right abdomen
If you experience any of these symptoms, there is a possibility of HIV infection before or immediately after starting PrEP, rather than just side effects. Please consider getting tested at a specialized medical institution.
What PrEP Does Not Prevent
PrEP only prevents HIV. It does not protect against syphilis, chlamydia, gonorrhea, hepatitis B, herpes, HPV, or other STIs. While on PrEP, please consider using condoms and regular STI testing. For bacterial STIs, DoxyPEP, taken after sexual activity, is also an option.
Testing Schedule
Tests will be conducted according to guidelines. Regular testing is essential to safely continue PrEP.
| Test Item | Before Start | After Start |
|---|---|---|
| HIV | Required | Every 3 months |
| Syphilis, Gonorrhea, Chlamydia | Recommended | Every 3-6 months |
| Hepatitis B | Required | Every 1 year |
| Kidney Function | Required | Every 6 months for those 50 and over or with reduced kidney function, every 12 months for others |
If you cannot provide recent test results during the medical interview, we will send you HIV and Hepatitis B test kits for an additional fee. If you provide your test results, our test kits will not be required. *HIV test results within 1 month, Hepatitis B within 3 months, and kidney function within 6 months are valid.
Home testing kits can be found on our STI Testing page.
Notes on Unapproved Pharmaceuticals
- Unapproved drug status: The anti-HIV drug (generic name: tenofovir/emtricitabine combination generic) used at our clinic is not approved in Japan for the purpose of HIV prevention (PrEP).
- Acquisition route: The drug is imported by a doctor through a formal process with the Ministry of Health, Labour and and Welfare (acquisition of a Yakkan Shoumei, or import approval).
- Availability of approved domestic drugs: Medications with the same active ingredients are approved in Japan as HIV treatment drugs (Yes).
- Information on safety, etc., in other countries: PrEP is an established prevention method recommended by the US CDC and WHO guidelines and is used worldwide. However, effects on kidney function, decreased bone density, and worsening of hepatitis in individuals with hepatitis B who discontinue treatment have been reported.
- Health damage relief system: Health damage resulting from the use of unapproved drugs is not covered by the Pharmaceutical Side Effect Relief System.
- Cost and effectiveness: As this is a private medical service, health insurance does not apply, and the full cost is borne by the patient. The extent of effectiveness varies among individuals, and it is not guaranteed to completely prevent infection.
Procedure for Prescription at Our Clinic
| STEP | Content |
|---|---|
| 1. Order & Pre-consultation | Select your desired plan and place an order. You will then be asked to complete a pre-consultation questionnaire. Please be sure to provide recent test results (HIV, Hepatitis B, kidney function) if available. |
| 2. Online Consultation | The doctor will conduct counseling and prescribe medication via video call. You can also discuss Daily/On-Demand dosing methods. |
| 3. Shipping | Orders with video consultations completed by 15:00 daily will be shipped the same day. Delivered in discreet packaging. |
| 4. Regular Follow-up | Continue with HIV testing every 3 months, STI testing every 3-6 months, and regular Hepatitis B and kidney function tests. |
