From the Guidelines
PrEP medications for HIV include tenofovir disoproxil fumarate/emtricitabine once daily, with a recommended double dose on the first day for men who have sex with men (MSM), while there is no PrEP medication available for Hepatitis C, and prevention relies on avoiding exposure to contaminated blood. When considering HIV pre-exposure prophylaxis, the most recent guidelines from 1 recommend tenofovir disoproxil fumarate/emtricitabine as the first-line option, with considerations for individuals with kidney dysfunction, osteopenia, or osteoporosis to use tenofovir alafenamide/emtricitabine instead. Some key points to consider for HIV PrEP include:
- Initiation of PrEP as soon as feasible for individuals at risk for HIV infection
- The use of a 2-1-1 (or on-demand) method for oral PrEP, which is recommended only for MSM
- The potential for injectable cabotegravir every 8 weeks as an alternative PrEP option, pending regulatory approval and availability. For Hepatitis C, the focus is on treatment rather than prevention, with guidelines from 1 recommending direct-acting antivirals like sofosbuvir/velpatasvir or glecaprevir/pibrentasvir for 8-12 weeks to cure the infection after it has occurred. Key considerations for Hepatitis C treatment include:
- The importance of early testing and treatment to achieve the best outcomes
- The use of combination therapies like sofosbuvir and ledipasvir, sofosbuvir and velpatasvir, or sofosbuvir and daclatasvir for patients with acute Hepatitis C
- The potential need for extended treatment durations in patients with HIV coinfection or high baseline HCV RNA levels.
From the Research
HIV Pre-Exposure Prophylaxis (PrEP) Medications
- The combination antiretroviral regimen, tenofovir disoproxil fumarate (TDF)/emtricitabine, taken as a single pill once daily, has been shown to prevent HIV transmission 2, 3.
- Studies have demonstrated that preexposure prophylaxis (PrEP) with daily dosing of TDF/emtricitabine significantly reduces HIV acquisition in men who have sex with men, high-risk heterosexuals, and injection drug users who share injection equipment 3, 4.
- The efficacy of daily TDF/emtricitabine exceeds 90% but is highly correlated with degree of adherence 3.
- TDF/emtricitabine is safe and well-tolerated, with only 2% of people discontinuing PrEP because of adverse effects 3.
Hepatitis C (Hep C) and HIV Co-Infection
- There is no direct evidence in the provided studies regarding Hep C prep medications.
- However, it is essential to note that individuals co-infected with HIV and Hep C may require special consideration when using PrEP medications, and healthcare providers should carefully monitor their patients for potential interactions and adverse effects.
Key Considerations for PrEP Medications
- Adherence to PrEP is central to realizing its benefit in preventing HIV infection 5.
- The US Preventive Services Task Force recommends offering PrEP with effective antiretroviral therapy to persons at high risk of HIV acquisition 5.
- Provider identification of people at high risk for HIV transmission is crucial for increasing utilization of PrEP therapy 6.
- Advances in PrEP development will expand options and access for people and reduce the risk of HIV acquisition 6.