Pre-exposure prophylaxis for HIV - Revision history

Aidan at 02:27, 2 April 2023

2023-04-02T02:27:03Z

← Older revision		Revision as of 02:27, 2 April 2023
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	*First-line, continuous: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg daily		*First-line, continuous: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg daily
	*Alternative, continuous: [[tenofovir alafenamide]]/[[emtricitabine]] 25 mg/200 mg PO daily, if they can afford it		*Alternative, continuous: [[tenofovir alafenamide]]/[[emtricitabine]] 25 mg/200 mg PO daily, if they can afford it
	*Alternative, on-demand: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg two pills taken 2 to 24 hours before first exposure and continued daily until 48 hours after last exposure		*Alternative, on-demand (2-1-1): [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg two pills taken 2 to 24 hours before first exposure and continued daily until 48 hours after last exposure
	*Continuous prophylaxis should be prescribed for 3 months at a time without repeats, with follow-up every 3 months to give a new prescription		*Continuous prophylaxis should be prescribed for 3 months at a time without repeats, with follow-up every 3 months to give a new prescription
	*Connect to mental health and other services, if indicated		*Connect to mental health and other services, if indicated

Aidan: /* Treatment */

2020-09-24T13:58:50Z

Treatment

← Older revision		Revision as of 13:58, 24 September 2020
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	*Alternative, on-demand: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg two pills taken 2 to 24 hours before first exposure and continued daily until 48 hours after last exposure		*Alternative, on-demand: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg two pills taken 2 to 24 hours before first exposure and continued daily until 48 hours after last exposure
	*Continuous prophylaxis should be prescribed for 3 months at a time without repeats, with follow-up every 3 months to give a new prescription		*Continuous prophylaxis should be prescribed for 3 months at a time without repeats, with follow-up every 3 months to give a new prescription
⚫	*Counsel on condom use and side effects
	*Connect to mental health and other services, if indicated		*Connect to mental health and other services, if indicated
			*For continuous PrEP, wait 7 days before condomless sex if topping or 2 to 3 weeks if bottomming
		⚫	**Counsel on condom use and side effects

	===Follow-Up===		===Follow-Up===

Aidan: /* Treatment */

2020-09-24T13:54:31Z

Treatment

← Older revision		Revision as of 13:54, 24 September 2020
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	*First-line, continuous: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg daily		*First-line, continuous: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg daily
	*Alternative, continuous: [[tenofovir alafenamide]]/[[emtricitabine]] 25 mg/200 mg PO daily, if they can afford it		*Alternative, continuous: [[tenofovir alafenamide]]/[[emtricitabine]] 25 mg/200 mg PO daily, if they can afford it
	*Alternative, on-demand: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg taken 2 to 24 hours before first exposure and continued daily until 48 hours after last exposure		*Alternative, on-demand: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg two pills taken 2 to 24 hours before first exposure and continued daily until 48 hours after last exposure
	*Continuous prophylaxis should be prescribed for 3 months at a time without repeats, with follow-up every 3 months to give a new prescription		*Continuous prophylaxis should be prescribed for 3 months at a time without repeats, with follow-up every 3 months to give a new prescription
	*Counsel on condom use and side effects		*Counsel on condom use and side effects

Aidan: /* Treatment */

2020-09-24T13:52:51Z

Treatment

← Older revision		Revision as of 13:52, 24 September 2020
Line 35:		Line 35:

	*First-line, continuous: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg daily		*First-line, continuous: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg daily
	*Alternative, continuous: [[tenofovir alafenamide]]/[[emtricitabine]] 25 mg/200 mg PO daily		*Alternative, continuous: [[tenofovir alafenamide]]/[[emtricitabine]] 25 mg/200 mg PO daily, if they can afford it
	*Alternative, on-demand: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg taken 2 to 24 hours before first exposure and continued daily until 48 hours after last exposure		*Alternative, on-demand: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg taken 2 to 24 hours before first exposure and continued daily until 48 hours after last exposure
	*Continuous prophylaxis should be prescribed for 3 months at a time without repeats, with follow-up every 3 months to give a new prescription		*Continuous prophylaxis should be prescribed for 3 months at a time without repeats, with follow-up every 3 months to give a new prescription

Aidan: /* Follow-up */

2020-09-24T13:52:33Z

Follow-up

← Older revision		Revision as of 13:52, 24 September 2020
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	*Connect to mental health and other services, if indicated		*Connect to mental health and other services, if indicated

	===Follow-up===		===Follow-Up===

	*Follow-up after 30 days and then every 3 months thereafter		*Follow-up after 30 days and then every 3 months thereafter

Aidan: /* Follow-up */

2020-09-24T13:02:21Z

Follow-up

← Older revision		Revision as of 13:02, 24 September 2020
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	! colspan="5" \|Laboratory Evaluation		! colspan="5" \|Laboratory Evaluation
	\|-		\|-
	\|HIV test		\|[[HIV]] test
	\| style="text-align:center;" \|X		\| style="text-align:center;" \|X
	\| style="text-align:center;" \|X		\| style="text-align:center;" \|X
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	\|		\|
	\|-		\|-
	\|Hepatitis A immunity		\|[[Hepatitis A virus\|Hepatitis A]] immunity
	\| style="text-align:center;" \|X		\| style="text-align:center;" \|X
	\|		\|
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	\|		\|
	\|-		\|-
	\|Hepatitis B screen		\|[[Hepatitis B virus\|Hepatitis B]] screen
	\| style="text-align:center;" \|X		\| style="text-align:center;" \|X
	\|		\|
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	\|if unvaccinated		\|if unvaccinated
	\|-		\|-
	\|Hepatitis C screen		\|[[Hepatitis C virus\|Hepatitis C]] screen
	\|		\|
	\|		\|
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	\| style="text-align:center;" \|X		\| style="text-align:center;" \|X
	\|-		\|-
	\|Screen for gonorrhea and chlamydia		\|Screen for [[gonorrhea]] and [[chlamydia]]
	\| style="text-align:center;" \|X		\| style="text-align:center;" \|X
	\|		\|
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	\|		\|
	\|-		\|-
	\|Syphilis serology		\|[[Syphilis]] serology
	\| style="text-align:center;" \|X		\| style="text-align:center;" \|X
	\|		\|

Aidan: /* Treatment */

2020-09-24T13:01:25Z

Treatment

← Older revision		Revision as of 13:01, 24 September 2020
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	===Treatment===		===Treatment===

	*First-line, continuous: [[~~Tenofovir~~ disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg daily		*First-line, continuous: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg daily
	*Alternative, continuous: [[tenofovir alafenamide]]/[[emtricitabine]] 25 mg/200 mg PO daily		*Alternative, continuous: [[tenofovir alafenamide]]/[[emtricitabine]] 25 mg/200 mg PO daily
	*Alternative, on-demand: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg taken 2 to 24 hours before first exposure and continued daily until 48 hours after last exposure		*Alternative, on-demand: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg taken 2 to 24 hours before first exposure and continued daily until 48 hours after last exposure

Aidan: /* Follow-up */

2020-09-24T12:58:42Z

Follow-up

← Older revision		Revision as of 12:58, 24 September 2020
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	\|-		\|-
	\|Symptoms of HIV seroconverion		\|Symptoms of HIV seroconverion
			\| style="text-align:center;" \|X
	\|x
			\| style="text-align:center;" \|X
	\|x
			\| style="text-align:center;" \|X
	\|x
	\|		\|
	\|-		\|-
	\|PrEP adherence and side effects		\|PrEP adherence and side effects
	\|		\|
			\| style="text-align:center;" \|X
	\|x
			\| style="text-align:center;" \|X
	\|x
	\|		\|
	\|-		\|-
	\|Assess indication for PrEP		\|Assess indication for PrEP
			\| style="text-align:center;" \|X
	\|x
			\| style="text-align:center;" \|X
	\|x
			\| style="text-align:center;" \|X
	\|x
	\|		\|
	\|-		\|-
	\|Counsel on prevention of HIV and STIs		\|Counsel on prevention of HIV and STIs
			\| style="text-align:center;" \|X
	\|x
			\| style="text-align:center;" \|X
	\|x
			\| style="text-align:center;" \|X
	\|x
	\|		\|
	\|-		\|-
	\|Assess and manage other syndemic conditions, including drug and alcohol use		\|Assess and manage other syndemic conditions, including drug and alcohol use
			\| style="text-align:center;" \|X
	\|x
			\| style="text-align:center;" \|X
	\|x
			\| style="text-align:center;" \|X
	\|x
	\|		\|
	\|-		\|-
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	\|-		\|-
	\|HIV test		\|HIV test
			\| style="text-align:center;" \|X
	\|x
			\| style="text-align:center;" \|X
	\|x
			\| style="text-align:center;" \|X
	\|x
	\|		\|
	\|-		\|-
	\|Hepatitis A immunity		\|Hepatitis A immunity
			\| style="text-align:center;" \|X
	\|x
	\|		\|
	\|		\|
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	\|-		\|-
	\|Hepatitis B screen		\|Hepatitis B screen
			\| style="text-align:center;" \|X
	\|x
	\|		\|
	\|		\|
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	\|		\|
	\|		\|
			\| style="text-align:center;" \|X
	\|x
	\|-		\|-
	\|Screen for gonorrhea and chlamydia		\|Screen for gonorrhea and chlamydia
			\| style="text-align:center;" \|X
	\|x
	\|		\|
			\| style="text-align:center;" \|X
	\|x
	\|		\|
	\|-		\|-
	\|Syphilis serology		\|Syphilis serology
			\| style="text-align:center;" \|X
	\|x
	\|		\|
			\| style="text-align:center;" \|X
	\|x
	\|		\|
	\|-		\|-
	\|CBC		\|CBC
			\| style="text-align:center;" \|X
	\|x
	\|		\|
			\| style="text-align:center;" \|X
	\|x
	\|		\|
	\|-		\|-
	\|Creatinine		\|Creatinine
			\| style="text-align:center;" \|X
	\|x
			\| style="text-align:center;" \|X
	\|x
			\| style="text-align:center;" \|X
	\|x
	\|		\|
	\|-		\|-
	\|Urinalysis		\|Urinalysis
			\| style="text-align:center;" \|X
	\|x
	\|		\|
	\|		\|
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	\|-		\|-
	\|Pregnancy test (if appropriate)		\|Pregnancy test (if appropriate)
			\| style="text-align:center;" \|X
	\|x
	\|		\|
			\| style="text-align:center;" \|X
	\|x
	\|		\|
	\|}		\|}

Aidan at 12:57, 24 September 2020

2020-09-24T12:57:12Z

← Older revision		Revision as of 12:57, 24 September 2020
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	*Works when adherent, but adherence is often poor		*Works when adherent, but adherence is often poor

	== Management ==		==Management==

	===Assessing Eligibility===		===Assessing Eligibility===
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	===Treatment===		===Treatment===

	*[[Tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg daily ~~for 3 months at a time, without repeats~~		*First-line, continuous: [[Tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg daily
	*~~On-demand~~ ~~alternative~~: [[tenofovir ~~disoproxil fumarate~~]]/[[emtricitabine]] ~~300~~ mg/200 mg ~~taken 2 to 24 hours before first exposure and continued~~ daily ~~until 48 hours after last exposure~~		*Alternative, continuous: [[tenofovir alafenamide]]/[[emtricitabine]] 25 mg/200 mg PO daily
			*Alternative, on-demand: [[tenofovir disoproxil fumarate]]/[[emtricitabine]] 300 mg/200 mg taken 2 to 24 hours before first exposure and continued daily until 48 hours after last exposure
			*Continuous prophylaxis should be prescribed for 3 months at a time without repeats, with follow-up every 3 months to give a new prescription
	*Counsel on condom use and side effects		*Counsel on condom use and side effects
		⚫	*Connect to mental health and other services, if indicated
	**Take it for 7 days before it is effective
⚫	**Connect to mental health and other services, if indicated

	===Follow-up===		===Follow-up===

Aidan at 10:18, 24 September 2020

2020-09-24T10:18:56Z

← Older revision		Revision as of 10:18, 24 September 2020
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	== Background ==		==Background==

	*Principle: give HIV meds to high-risk individuals to prevent seroconversion if exposed		*Principle: give HIV meds to high-risk individuals to prevent seroconversion if exposed
	*Works when adherent, but adherence is often poor		*Works when adherent, but adherence is often poor

	==~~Eligibility~~==		== Management ==

			===Assessing Eligibility===

	*'''MSM:''' condomless anal sex within the last 6 months, and any of:		*'''MSM:''' condomless anal sex within the last 6 months, and any of:
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	**People who inject drugs may not benefit as much		**People who inject drugs may not benefit as much

		⚫	===Baseline Investigations===
	==Process==

⚫	===Baseline===

	*[[HBV]] (sAb, sAg, and cAb); [[HCV]]; and [[HAV]], so you can vaccinate		*[[HBV]] (sAb, sAg, and cAb); [[HCV]]; and [[HAV]], so you can vaccinate
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	==Further Reading==		==Further Reading==

	*Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis. ''CMAJ'' 2017;189(47):e1448-e1458. doi: [https://doi.org/10.1503/cmaj.170494 10.1503/cmaj.170494]		*Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis. ''CMAJ''. 2017;189(47):e1448-e1458. doi: [https://doi.org/10.1503/cmaj.170494 10.1503/cmaj.170494]

	[[Category:HIV]]		[[Category:HIV]]