Recommended Regimens for HIV Pre-Exposure Prophylaxis (PrEP)
The recommended standard regimen for HIV pre-exposure prophylaxis (PrEP) is daily oral Truvada, which contains emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg in a single tablet. 1
Primary PrEP Options
Daily Oral PrEP (First-Line Option)
- Standard regimen: Tenofovir disoproxil fumarate (TDF) 300 mg/emtricitabine (FTC) 200 mg (Truvada) once daily 2, 1
- Efficacy exceeds 90% when adherence is high 3
- Protection is achieved with consistent daily use
- Appropriate for all populations at risk for HIV infection
Alternative Dosing Strategies (For MSM Only)
- 2-1-1 (On-Demand) Dosing:
Monitoring and Follow-Up Requirements
Initial Screening (Before Starting PrEP)
- HIV testing using combination antigen-antibody assay (mandatory) 2, 1
- Serum creatinine and estimated glomerular filtration rate 2, 1
- Hepatitis B surface antigen testing 2, 1
- STI screening (gonorrhea, chlamydia, syphilis) 1
- Pregnancy testing for women 1
Follow-Up Schedule
- 30-day follow-up after initiation to assess adverse effects and support adherence 2
- HIV testing every 3 months 2, 1
- STI screening every 3 months 2, 1
- Creatinine measurement at least every 6 months 2, 1
- HCV serologic testing at least annually (more frequently for high-risk individuals) 2
Special Considerations and Contraindications
Renal Function
- TDF-based PrEP is contraindicated in persons with creatinine clearance <60 mL/min/1.73m² 2, 1
- For MSM with creatinine clearance between 30-60 mL/min who have osteopenia/osteoporosis: Consider tenofovir alafenamide/emtricitabine (TAF/FTC) 1, 4
- TAF/FTC has shown non-inferior efficacy with more favorable effects on bone mineral density and renal safety 4
Not Recommended Regimens
- TDF/lamivudine, TAF/emtricitabine (except in specific cases noted above), and TDF alone are not recommended for PrEP 2
Common Pitfalls and Important Considerations
Critical Adherence Factors
- Adherence is crucial for PrEP efficacy 1, 3
- Each visit should be used to assess and troubleshoot barriers to adherence 2
- PrEP prescriptions should not exceed 90 days without interval HIV testing 2
Safety Concerns
- Most common adverse events: nausea, elevated creatinine, and decreased bone mineral density 5
- Only about 2% of people discontinue PrEP due to adverse effects 3
Avoiding Resistance Development
- Never start PrEP without confirming HIV-negative status 1
- HIV RNA testing should be obtained if acute HIV is suspected 2
- If HIV infection is confirmed in someone using PrEP, a recommended initial antiretroviral regimen should be started pending resistance testing 2
Continued Risk Reduction
- PrEP does not protect against other STIs, so regular STI screening is essential 1
- PrEP should be used in conjunction with other safer sex practices 3
By following these guidelines for PrEP initiation and monitoring, healthcare providers can effectively help reduce the risk of HIV acquisition in high-risk individuals, which has been shown to decrease new HIV infections by 74-92% among participants with detectable drug levels 5.