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With a recent (2/8/16) high-profile court ruling backing funding for pre-exposure prophylaxis (PrEP) for HIV prevention, what is PrEP, why is it so controversial, and why should every clinician be advocating for this blockbuster drug?The public health impact of HIV in the UK is immense. Record numbers of people are now living with the virus and over 4000 new cases are identified each year.1 With recent studies estimating lifetime treatment costs to be over £360 000 per person, each new HIV diagnosis only adds further to this already immense, yet preventable, burden in our over-stretched health system.2Men who have sex with men (MSM) are at the highest risk for HIV acquisition in the UK. Of the 4155 new diagnoses, over 81% were MSM, translating to a staggering 1 in every 20 MSM males aged 15–44 years having HIV, rising even further to 1 in every 11 in London.1Although Public Health England (PHE) has invested significantly to curtail this epidemic, we are still seeing a rise in both incidence numbers and rates year on year. Why is this, and can more be done? Could PrEP be the magic bullet at our fingertips?PrEP is a novel way of using antiretroviral medication (ARV) in people who are HIV negative to avoid contracting HIV. Multiple studies have confirmed its efficacy in reducing HIV acquisition in MSM,3 heterosexual couples (where one partner is HIV positive),4 and in people who inject drugs (PWID),5 all of whom are high-risk patients we encounter in our daily practices.It was in 2015 that the UK-based Pragmatic Open-Label Randomised Trial of Pre-exposure Prophylaxis (PROUD) study gave a platform to PrEP by showing how it would work within the UK and the NHS. The study showed a staggering 86% reduction in …

HIV pre-exposure prophylaxis: the primary care implications of prescribing restrictions