Pre-exposure prophylaxis for HIV: Difference between revisions

Revision as of 08:57, 24 September 2020

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

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
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

HBV (sAb, sAg, and cAb); HCV; and HAV, so you can vaccinate
STI screening
- Syphilis, chlamydia, and gonorrhea
- Urethral, pharyngeal, and rectal
Vaccinations
- HAV and HBV, if not immune
- HPV, if eligible

First-line, continuous: Tenofovir disoproxil fumarate/emtricitabine 300 mg/200 mg 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
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

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

@@ Line 4: / Line 4: @@
 *Works when adherent, but adherence is often poor
-== Management ==
+==Management==
 ===Assessing Eligibility===
@@ Line 34: / Line 34: @@
 ===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
+*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===