Pre-exposure prophylaxis for HIV

• 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.