What is the recommended frequency for HIV and Sexually Transmitted Infections (STIs) testing in patients using on-demand Pre-Exposure Prophylaxis (PrEP)?

From the Guidelines

Patients using on-demand Pre-Exposure Prophylaxis (PrEP) should be tested for HIV and Sexually Transmitted Infections (STIs) quarterly, including combined HIV antibody and antigen test, genital and nongenital gonorrhea and chlamydia testing by NAAT, and syphilis testing. This recommendation is based on the 2020 guidelines from the International Antiviral Society-USA panel, published in JAMA 1. The quarterly testing is crucial to ensure the patient's safety and the effectiveness of PrEP, as it only protects against HIV and not other STIs.

The testing schedule should include:

• At 1 month: Combined HIV antibody and antigen test 1
• Quarterly:
  • Combined HIV antibody and antigen test 1
  • Genital and nongenital gonorrhea and chlamydia testing by NAAT 1
  • Syphilis testing 1
  • Estimated creatinine clearance rate (at first quarterly visit and annually thereafter) 1
  • Pregnancy testing for individuals of childbearing potential 1
• Annually:
  • Combined HIV antibody and antigen test 1
  • Estimated creatinine clearance rate 1
  • Hepatitis C virus antibody test (every 3–6 months for people who inject drugs and MSM who use recreational drugs at the time of sex if liver function test results are abnormal) 1

Regular testing is essential to monitor the patient's health and adjust the treatment plan as needed. Additionally, patients should be counseled about the importance of adhering to the dosing schedule for maximum protection, as on-demand PrEP is currently only recommended for specific populations. The use of exogenous estrogens or androgen blockers by transfeminine persons may result in reduced protection, and additional measures to support maximal adherence to daily dosing is recommended 1.

From the Research

HIV and STIs Testing Frequency for On-Demand PrEP Users

• The recommended frequency for HIV and Sexually Transmitted Infections (STIs) testing in patients using on-demand Pre-Exposure Prophylaxis (PrEP) is every 3 months 2, 3.
• This frequency is based on studies that have shown low HIV incidence and modest increases in bacterial STIs among on-demand PrEP users 2, 3.
• Regular testing is important to monitor the effectiveness of PrEP and to detect any potential STIs or HIV infections early 4, 5.
• Some studies suggest that online-mediated PrEP care and reduced frequency of monitoring may be noninferior to standard PrEP care, but more research is needed to determine the optimal frequency for monitoring 4.

Key Considerations

• On-demand PrEP users should be tested for HIV and STIs every 3 months to ensure the effectiveness of PrEP and to detect any potential infections early 2, 3.
• Clinicians should familiarize themselves with the appropriate use of on-demand PrEP, including its advantages and disadvantages, and provide clinical counseling points to patients 5.
• Regular monitoring and testing are crucial to preventing HIV and STIs among on-demand PrEP users 2, 3, 4.