Sir, the case of National Aids Trust vs NHS England1 in late 2016 stemmed a revolutionary breakthrough in the management of HIV in the UK which all medical professionals should be aware of. The court ruling deemed that the NHS can fund pre-exposure prophylaxis (PrEP) for those at risk of contracting HIV.

A 2014 government report2 stated there are about 107,800 individuals living with HIV in the UK with an overall prevalence of 2.8 per 1,000 population aged 15–59 years. PrEP is a method to reduce the rate of transmission of HIV. The brand name Truvada consists of two anti-retroviral agents, emtricitabine and tenofovir. The logic is to give the medication to HIV negative patients prior to high risk behaviours to reduce the chance of later obtaining HIV. It can either be taken regularly ie one tablet per day, or only taken when needed, just prior to or following intercourse. The PROUD study3 indicated that there was a relative risk reduction of obtaining HIV of 86% in high risk sexual intercourse.

Despite the positive court ruling, the NHS has not yet started rolling out the medication en masse, largely due to the cost of the medication. A pack of 30 days of treatment costs £355.73.4 Instead a three-year trial starting in December 2016 consisting of 10,000 participants will be conducted to assess the efficacy of the medication.

Even though the medication is not currently being funded, there are numerous sources available to patients to self-fund. Several websites have been set up to provide patients with resources to get medications, but this can lead to an increased black market supply of these medications. In order to combat this problem nationwide, many genitourinary clinics are now offering advice and support on purchasing PrEP in a safe and affordable manner. As dentists and other health professionals have an intimate relationship with patients, patients may disclose facts about risky behaviour to their health provider. Therefore, it is of utmost importance that the general dentist should be able to provide guidance and have some knowledge on where to obtain support for patients involved in high-risk behaviour.