From the Guidelines
PrEP is recommended for individuals at risk for HIV infection, with tenofovir disoproxil fumerate/emtricitabine once daily being the preferred oral PrEP regimen 1. The use of PrEP has been shown to be highly effective in preventing HIV infection in people at risk, with a significant reduction in HIV acquisition observed in clinical trials 1.
Key Recommendations for PrEP
- Tenofovir disoproxil fumerate/emtricitabine once daily is recommended for oral PrEP 1
- For men who have sex with men (MSM), a double dose (2 pills) of tenofovir disoproxil fumerate/emtricitabine is recommended on the first day 1
- Oral PrEP dosing using the 2-1-1 (or on-demand) method is recommended only for MSM 1
- Injectable cabotegravir every 8 weeks is recommended (pending approval by regulatory agencies and availability) as PrEP for cisgender men and transgender women who have sex with men 1
Important Considerations
- PrEP requires regular medical follow-up every 3 months for HIV testing, STI screening, and kidney function monitoring
- Side effects are generally mild and may include nausea, headache, or fatigue, typically resolving within the first month
- PrEP works by maintaining sufficient levels of antiretroviral medication in the bloodstream and tissues to prevent HIV from establishing infection if exposure occurs
- It's essential to note that PrEP only protects against HIV, not other sexually transmitted infections, so condom use is still recommended for comprehensive protection 1
From the Research
HIV Pre-Exposure Prophylaxis (PrEP)
- PrEP is a highly effective method for preventing HIV transmission, with studies showing that daily dosing of tenofovir disoproxil fumarate (TDF)/emtricitabine can reduce HIV acquisition by more than 90% 2, 3.
- The efficacy of PrEP is highly correlated with adherence, and regular monitoring is necessary to ensure optimal adherence and minimize the risk of adverse effects 2, 4.
- PrEP is recommended for individuals at high risk of acquiring HIV, including men who have sex with men, high-risk heterosexuals, and injection drug users who share injection equipment 2, 4.
Safety and Tolerability
- TDF/emtricitabine is generally safe and well-tolerated, with fewer than 2% of individuals discontinuing PrEP due to adverse effects 2.
- Common adverse effects include nausea, abdominal pain, headache, and increased creatinine 4.
- Resistance to TDF/emtricitabine is rare, but can occur in individuals with undiagnosed acute HIV infection 2.
Real-World Implementation
- Despite its efficacy, PrEP is underutilized, with fewer than 20% of eligible individuals in the United States using PrEP 2.
- Barriers to PrEP use include lack of awareness, high cost, and concerns about adherence and resistance 5, 6.
- New PrEP agents and technologies are being developed to address these challenges and expand access to PrEP, including novel oral agents, long-acting injectables, and multipurpose technologies 6.
Clinical Practice
- Primary care providers play a critical role in implementing PrEP, and guidelines and toolkits are available to support PrEP prescription and monitoring 4.
- Regular office visits are necessary to ensure adherence, provide ongoing counseling, and monitor for side effects 4.
- Pharmacists can also play a key role in optimizing PrEP implementation and addressing barriers to access 5.