Pre-exposure prophylaxis for HIV: Difference between revisions
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+ | ==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 |
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*Works when adherent, but adherence is often poor |
*Works when adherent, but adherence is often poor |
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+ | == Management == |
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| + | ===Assessing Eligibility=== |
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*'''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 |
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| − | ==Process== |
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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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==Further Reading== |
==Further Reading== |
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| − | *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]] |
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Revision as of 06:18, 24 September 2020
Background
- Principle: give HIV meds to high-risk individuals to prevent seroconversion if exposed
- Works when adherent, but adherence is often poor
Management
Assessing Eligibility
- MSM: condomless anal sex within the last 6 months, and any of:
- Sexually transmitted infection within the last 12 months
- Recurrent use of HIV PEP at least twice
- Ongoing sexual relationship with an HIV-positive partner who has a detectable viral load or is not on treatment
- Stop if partner is undetectable for 6 months
- HIV incidence risk index for men who have sex with men (HIRI-MSM) ≥11
- Heterosexual exposure
- Ongoing condomless sexual relationship with an HIV-positive partner who has a detectable viral load or is not on treatment
- Stop if partner is undetectable for 6 months
- Can be considered even if condomless sexual relationship with an HIV-positive partner with low risk
- Ongoing condomless sexual relationship with an HIV-positive partner who has a detectable viral load or is not on treatment
- People who inject drugs
- Consider if they share drug paraphernalia with someone who has risk of HIV
- People who inject drugs may not benefit as much
Baseline Investigations
Treatment
- Tenofovir disoproxil fumarate/emtricitabine 300 mg/200 mg daily for 3 months at a time, without repeats
- 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
- 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 after 30 days and then every 3 months thereafter
| Item | Baseline | 30 days | q3mo | q12mo |
|---|---|---|---|---|
| Clinical Evaluation | ||||
| Symptoms of HIV seroconverion | x | x | x | |
| PrEP adherence and side effects | x | x | ||
| Assess indication for PrEP | x | x | x | |
| Counsel on prevention of HIV and STIs | x | x | x | |
| Assess and manage other syndemic conditions, including drug and alcohol use | x | x | x | |
| Laboratory Evaluation | ||||
| HIV test | x | x | x | |
| Hepatitis A immunity | x | |||
| Hepatitis B screen | x | if unvaccinated | ||
| Hepatitis C screen | x | |||
| Screen for gonorrhea and chlamydia | x | x | ||
| Syphilis serology | x | x | ||
| CBC | x | x | ||
| Creatinine | x | x | x | |
| Urinalysis | x | |||
| Pregnancy test (if appropriate) | x | x | ||
Further Reading
- Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis. CMAJ. 2017;189(47):e1448-e1458. doi: 10.1503/cmaj.170494
