Pre-exposure prophylaxis for HIV: Difference between revisions
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= HIV pre-exposure prophylaxis (PrEP) = |
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== Background == |
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* Works when adherent, but adherence is poor |
* Works when adherent, but adherence is poor |
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= Eligibility = |
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* MSM with multiple unprotected exposures, or HIV-positive partner, or sex work |
* MSM with multiple unprotected exposures, or HIV-positive partner, or sex work |
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** People who inject drugs may not benefit as much |
** People who inject drugs may not benefit as much |
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= Process = |
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== Baseline == |
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* 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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** HPV, if eligible |
** HPV, if eligible |
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== Treatment == |
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* Tenofovir/emtricitabine 1 tablet daily for 3 months at a time, without repeats |
* Tenofovir/emtricitabine 1 tablet daily for 3 months at a time, without repeats |
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** Connect to mental health and other services, if indicated |
** Connect to mental health and other services, if indicated |
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== Follow-up == |
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* Follow-up every 3-4 months |
* Follow-up every 3-4 months |
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* Screen for drug and alcohol abuse |
* Screen for drug and alcohol abuse |
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= Further Reading = |
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* Tan ''et al''. [https://doi.org/10.1503/cmaj.170494 Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis]. ''CMAJ'' 2017;189(47):e1448-e1458. |
* Tan ''et al''. [https://doi.org/10.1503/cmaj.170494 Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis]. ''CMAJ'' 2017;189(47):e1448-e1458. |
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Revision as of 11:07, 13 August 2019
- Principle: give HIV meds to high-risk individuals to prevent seroconversion if exposed
- Works when adherent, but adherence is poor
Eligibility
- MSM with multiple unprotected exposures, or HIV-positive partner, or sex work
- Women with high number of unprotected partners, HIV-positive parter, or sex work
- People who inject drugs and share needles
- However,
- If a positive partner is undetectable for 6 months, no need for PrEP
- People who inject drugs may not benefit as much
Process
Baseline
- HBV sAb, sAg, and cAb; HCV; and HAV, so you can vaccinate
- STI screening
- Syphilis, chlamydia, and gonorrhea
- Urethral, pharyngeal, and rectal
- Vaccinations
- HAV, if not immune
- HPV, if eligible
Treatment
- Tenofovir/emtricitabine 1 tablet daily for 3 months at a time, without repeats
- Counsel on condom use and side effects
- Take it for 7 days before it is effective
- Connect to mental health and other services, if indicated
Follow-up
- Follow-up every 3-4 months
- Ask about HIV and STI symptoms, and screen them
- Side effects of medications
- Reassess need for PrEP
- Screen for drug and alcohol abuse
Further Reading
- Tan et al. Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis. CMAJ 2017;189(47):e1448-e1458.
