From the Guidelines
The choice of HIV PrEP medication should be based on patient-specific factors, with tenofovir disoproxil fumarate/emtricitabine being the recommended oral PrEP for most individuals, and tenofovir alafenamide/emtricitabine or injectable cabotegravir being considered for specific populations or preferences. When determining which HIV PrEP medication to start a patient on, several factors should be considered, including the patient's HIV transmission risk, kidney function, bone density, and personal preferences regarding daily pills versus injections.
Key Considerations
- Patient-specific factors, such as kidney function and bone density, should be taken into account when selecting a PrEP regimen 1.
- Tenofovir disoproxil fumarate/emtricitabine is recommended as the first-line oral PrEP for most individuals, due to its high efficacy and established safety profile 1.
- Tenofovir alafenamide/emtricitabine may be considered for individuals with kidney dysfunction, osteopenia, or osteoporosis, as it has a more favorable renal and bone safety profile compared to tenofovir disoproxil fumarate/emtricitabine 1.
- Injectable cabotegravir is a long-acting option that may be suitable for individuals who prefer injections over daily pills, and has been shown to be effective in preventing HIV infection in cisgender men and transgender women who have sex with men 1.
Additional Factors
- Patient preferences, potential side effects, drug interactions, cost, insurance coverage, and adherence patterns should also be considered when selecting a PrEP regimen.
- Before initiating PrEP, it is essential to confirm HIV-negative status, assess kidney function, screen for hepatitis B, and test for other STIs.
- Regular follow-up every 3 months is crucial to monitor for HIV, medication side effects, and adherence challenges. According to the 2020 recommendations of the International Antiviral Society-USA panel, tenofovir disoproxil fumarate/emtricitabine is the recommended oral PrEP for most individuals, with tenofovir alafenamide/emtricitabine being considered for specific populations or preferences 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Determining HIV PrEP Medication
To determine which HIV PrEP medication to start a patient on, several factors should be considered, including:
- The patient's risk of acquiring HIV
- Their medical history and current health status
- Potential side effects and interactions with other medications
- The efficacy and safety of different PrEP regimens
Available PrEP Regimens
There are two main PrEP regimens:
- Emtricitabine and tenofovir disoproxil fumarate (TDF) 2, 3
- Emtricitabine and tenofovir alafenamide (TAF) 4, 5
Efficacy and Safety
Studies have shown that both regimens are effective in preventing HIV infection:
- Emtricitabine and TDF have been shown to reduce the risk of HIV infection by 44-75% 2
- Emtricitabine and TAF have been shown to be non-inferior to emtricitabine and TDF in preventing HIV infection, with a lower risk of renal toxicity and bone mineral density loss 4, 5
Considerations for Choosing a PrEP Regimen
When choosing a PrEP regimen, consider the following:
- Renal function: Emtricitabine and TAF may be a better option for patients with impaired renal function 6, 4
- Bone mineral density: Emtricitabine and TAF may be a better option for patients at risk of bone mineral density loss 4, 5
- Adherence: Patients should be able to adhere to the daily regimen and attend regular follow-up appointments 3, 5
- Cost and accessibility: The cost and accessibility of the medication should be considered, as well as the patient's ability to access regular follow-up care 3