From the Guidelines
HIV PrEP treatment should be initiated as soon as feasible for individuals at risk for HIV infection, with the recommended regimen being tenofovir disoproxil fumarate/emtricitabine once daily, as stated in the 2020 recommendations of the international antiviral society-USA panel 1. The most effective PrEP options include daily oral pills, such as Truvada (emtricitabine 200mg/tenofovir disoproxil fumarate 300mg) or Descovy (emtricitabine 200mg/tenofovir alafenamide 25mg), both taken once daily with or without food. Some key points to consider when prescribing PrEP include:
- The optimal PrEP regimen for a given person is the one that is most acceptable and congruent with their routes of potential HIV exposure, as stated in the 2024 recommendations of the international antiviral society-USA panel 1.
- For men who have sex with men (MSM), a double dose (2 pills) of tenofovir disoproxil fumarate/emtricitabine is recommended on the first day, with an evidence rating of AIIa 1.
- Injectable cabotegravir every 8 weeks is also recommended as PrEP for cisgender men and transgender women who have sex with men, pending approval by regulatory agencies and availability, with an evidence rating of AIb 1. Before starting PrEP, individuals must test negative for HIV and have normal kidney function. Regular follow-up visits every 3 months are necessary for HIV testing, STI screening, and monitoring for side effects. PrEP works by maintaining sufficient levels of antiretroviral medication in the bloodstream and genital tissues to prevent HIV from establishing infection. While highly effective when taken as prescribed (reducing HIV risk by more than 99%), PrEP does not protect against other sexually transmitted infections, so condom use is still recommended. Common side effects may include nausea, headache, and mild kidney function changes, but these typically resolve within the first month of treatment.
From the FDA Drug Label
The provided text does not directly address HIV prep treatment, but rather discusses the use of tenofovir disoproxil fumarate in the treatment of HIV-1 infection in various clinical trials. The FDA drug label does not answer the question.
From the Research
HIV Pre-Exposure Prophylaxis (PrEP) Treatment
- HIV PrEP treatment involves the use of antiretroviral medications to prevent HIV infection in high-risk individuals 2, 3, 4, 5, 6
- The combination of emtricitabine and tenofovir disoproxil fumarate (TDF) is a commonly used PrEP regimen, which has been shown to be effective in reducing the risk of HIV infection 2, 3, 4, 5, 6
- Studies have demonstrated that PrEP with TDF/emtricitabine can reduce the risk of HIV infection by up to 90% when taken daily 3
Efficacy and Safety of PrEP Regimens
- The efficacy of PrEP regimens has been evaluated in several clinical trials, which have shown that daily dosing of TDF/emtricitabine can significantly reduce HIV acquisition in high-risk individuals 2, 3, 5, 6
- Emtricitabine and tenofovir alafenamide (TAF) has been shown to be non-inferior to TDF/emtricitabine for HIV prevention, with improved bone mineral density and renal safety biomarkers 5, 6
- PrEP regimens are generally well-tolerated, with low rates of adverse events leading to discontinuation of the study drug 3, 5, 6
Implementation and Access to PrEP
- Despite the efficacy and safety of PrEP regimens, there are concerns regarding access to PrEP, including cost, adherence, and the potential for development of drug resistance 2, 3, 4
- Effective methods are needed to identify individuals at high risk for acquiring HIV, ensure their access to PrEP, and maximize medication adherence 3, 4
- Pharmacists can play a crucial role in optimizing PrEP implementation, including educating patients and providers about PrEP, monitoring adherence, and addressing concerns regarding safety and efficacy 4