What is Pre-Exposure Prophylaxis (PrEP)?

From the Guidelines

Pre-exposure prophylaxis (PrEP) is a highly effective medication strategy to prevent HIV infection in people at high risk, with the recommended regimen being Truvada (emtricitabine 200mg/tenofovir disoproxil fumarate 300mg) or Descovy (emtricitabine 200mg/tenofovir alafenamide 25mg) taken once daily, as recommended by the 2020 guidelines of the International Antiviral Society-USA panel 1. The use of PrEP has been shown to reduce the risk of HIV acquisition by up to 99% when taken as prescribed 1. The guidelines recommend that PrEP be initiated as soon as feasible for individuals who have chosen to use it, with regular follow-up every 3 months for HIV testing, medication adherence assessment, and side effect monitoring 1. Some key points to consider when prescribing PrEP include:

• HIV testing to confirm negative status before starting PrEP
• Kidney function tests and hepatitis B screening before starting PrEP
• STI screening before starting PrEP
• Regular follow-up every 3 months for HIV testing, medication adherence assessment, and side effect monitoring
• Common side effects include nausea, headache, and mild kidney function changes, which typically resolve within the first month of use It's also important to note that PrEP does not protect against other STIs or pregnancy, so condoms are still recommended. For men who have sex with men (MSM), a double dose (2 pills) of tenofovir disoproxil fumarate/emtricitabine is recommended on the first day, and oral PrEP dosing using the 2-1-1 (or on-demand) method is recommended only for MSM 1. Overall, PrEP is a highly effective strategy for preventing HIV infection in people at high risk, and its use should be considered in conjunction with other prevention methods, such as condoms and regular STI screening.

From the Research

Pre-Exposure Prophylaxis (PrEP) Overview

• Pre-exposure prophylaxis (PrEP) is an effective method for preventing HIV transmission, with a combination antiretroviral regimen of tenofovir disoproxil fumarate (TDF)/emtricitabine taken as a single pill once daily 2.
• The efficacy of daily TDF/emtricitabine exceeds 90% but is highly correlated with the degree of adherence 2.
• PrEP is recommended for individuals at high risk of acquiring HIV, including men who have sex with men, high-risk heterosexuals, and injection drug users who share injection equipment 2, 3.

Safety and Tolerability

• TDF/emtricitabine is safe and well-tolerated, with only 2% of people discontinuing PrEP due to adverse effects 2.
• Sexually transmitted infections are common among those using PrEP, and resistance to TDF/emtricitabine is rare (<0.1%) 2.
• Long-term safety monitoring is essential, particularly for renal function and bone mineral density 3.

Implementation and Access

• Despite its efficacy, PrEP use remains low, particularly among women in the United States 4.
• Women's health care providers play a crucial role in identifying individuals at high risk for HIV and providing access to PrEP 4.
• Primary care providers can also prescribe PrEP, and guidelines and toolkits are available to assist in incorporating PrEP into primary care practice 5.
• Barriers to PrEP uptake and persistence are complex and require multilevel solutions to increase access, uptake, and persistence in PrEP care for all 6.

Key Populations

• PrEP is recommended for certain injection drug users, nonmonogamous men who have sex with men, heterosexual women who have sex with men who have sex with men or injection drug users, and those in HIV serodiscordant relationships 5.
• Priority populations, including women and marginalized communities, require targeted efforts to increase access to PrEP and overcome barriers to uptake and persistence 6.