From the Guidelines
Screening for pre-exposure prophylaxis (PrEP) against HIV requires several key tests before initiation, including HIV testing, renal function tests, hepatitis B screening, STI screening, and pregnancy testing for women of childbearing potential, as recommended by the 2020 guidelines 1.
Key Screening Tests
- HIV testing to confirm negative status, as PrEP is only for HIV-negative individuals
- Renal function tests, such as estimated creatinine clearance rate, to monitor potential kidney function effects of PrEP medications like Truvada (tenofovir disoproxil fumarate/emtricitabine) and Descovy (tenofovir alafenamide/emtricitabine) 1
- Hepatitis B screening, as PrEP medications have activity against hepatitis B and discontinuation could cause hepatitis flares in infected individuals
- STI screening for gonorrhea, chlamydia, and syphilis, as these infections increase HIV risk
- Pregnancy testing for women of childbearing potential to inform counseling, though PrEP can be used during pregnancy
Follow-up Screening
After starting PrEP, follow-up HIV testing should occur every 3 months to ensure the patient remains HIV-negative, along with STI screening, renal function monitoring, and adherence counseling 1. Additionally, estimated creatinine clearance rate should be monitored at least every 6 months, and more frequently for patients with or at risk for kidney injury 1.
Importance of Screening
These screening requirements ensure PrEP is both safe and effective, as the medications work by preventing HIV from establishing infection in the body when taken consistently. Regular monitoring and screening also help identify potential side effects and complications early on, allowing for prompt intervention and management. By prioritizing these screening tests and follow-up monitoring, healthcare providers can help individuals at risk for HIV infection stay safe and healthy while using PrEP.
From the Research
Screening Requirements for Pre-Exposure Prophylaxis (PrEP) against Human Immunodeficiency Virus (HIV)
- The screening requirements for PrEP against HIV involve assessing an individual's risk of acquiring HIV, as well as their overall health and medical history 2.
- This includes testing for HIV, hepatitis B and C, and other sexually transmitted infections (STIs), as well as evaluating the individual's kidney function and liver enzymes 3.
- Individuals with active hepatitis B can safely use PrEP with daily oral emtricitabine and tenofovir disoproxil fumarate (FTC/TDF), but should be monitored for liver function and HBV DNA levels 3.
- Women who are pregnant or breastfeeding can also use PrEP, but should be closely monitored by their healthcare provider 4.
Key Considerations for PrEP Screening
- The Centers for Disease Control and Prevention (CDC) recommends that individuals at high risk of acquiring HIV, such as men who have sex with men (MSM) and heterosexual individuals with multiple sex partners, should be screened for PrEP eligibility 2.
- The screening process should also include education and counseling on the use of PrEP, as well as the importance of adherence to the medication regimen and regular follow-up appointments 5.
- New and emerging antiretroviral agents for PrEP, such as cabotegravir and lenacapavir, are being developed and may offer alternative options for individuals who are unable to use FTC/TDF 6.
Ongoing Research and Development
- Ongoing trials are investigating the efficacy and safety of new PrEP regimens, including intermittent PrEP (iPrEP) and vaginal or rectal PrEP 2.
- Researchers are also exploring the use of long-acting injectable formulations and intra-vaginal rings as alternative modalities for PrEP 4.
- The development of new PrEP agents and modalities is critical to addressing the ongoing HIV epidemic and providing individuals with effective and convenient options for preventing HIV acquisition 6.