Guideline for Pre-exposure Prophylaxis (PrEP) for HIV Prevention
PrEP Medicines
Most PrEP clinical trials have tested a combination of two antiretroviral drugs, tenofovir disoproxil fumarate (also called TDF, or tenofovir) and emtricitabine (also called FTC), taken in a single pill daily for HIV prevention. This combination pill (brand name Truvada) was approved by the US Food and Drug Administration (FDA) for use as an HIV treatment in 2004, and was approved as PrEP in July 2012. Some clinical studies have also evaluated the use of tenofovir on its own as a preventive drug, but this drug alone is not FDA-approved for PrEP.
Guidelines for PrEP
Use The new federal guidelines for health care providers recommend that PrEP be considered for people who are HIV-negative and at substantial risk for HIV infection. For sexual transmission, this includes anyone who is in an ongoing relationship with an HIV-positive partner. It also includes anyone who 1) is not in a mutually monogamous relationship with a partner who recently tested HIV-negative, and 2) is a • gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the past 6 months; or • heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners). For people who inject drugs, this includes those who have injected illicit drugs in past 6 months and who have shared injection equipment or been in drug treatment for injection drug use in the past 6 months. Health care providers should also discuss PrEP with heterosexual couples in which one partner is HIV-positive and the other is HIV-negative as one of several options to protect the partner who is HIV-negative during conception and pregnancy.
Clinically eligible:
• Documented negative HIV test before prescribing PrEP
• No signs/symptoms of acute HIV infection
• Normal renal function, no contraindicated medications
• Documented hepatitis B virus infection and vaccination status
Prescription
Daily, continuing, oral doeses of TDF/FTC (Truvada), ≤90 day supply
Other services:
• Follow-up visits at least every 3 months to provide:
• HIV test, medication adherence counseling, behavioral risk reduction support, side effect assessment, STD symptom assessment
• At 3 months and every 6 months after, assess renal function
• Every 6 months test for bacterial STDs
• Do oral/rectal STD testing
• Assess pregnancy intent
• Pregnancy test every 3 months
• Access to clean needles/ syringes and drug treatment services
Source: US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States —2014: a clinical practice guideline.
