PrEP to Prevent HIV and Promote Sexual Health Lead author: Rona M. Vail, MD, with the Medical Care Criteria Committee, updated February 2020
Contents Purpose of This Guideline............................................. 2 PrEP Efficacy ................................................................. 4 TDF/FTC Versus TAF/FTC as PrEP ................................. 5 Table 1: TDF/FTC Versus TAF/FTC as PrEP .......... 6 Risks and Benefits of TDF/FTC and TAF/FTC as PrEP .... 7 Box 1: Benefits and Risks of TDF/FTC and TAF/FTC as PrEP .................................................. 7
Table 3: Recommended Monitoring and Ongoing Laboratory Testing for Patients Taking TDF/FTC or TAF/FTC as PrEP ............................................21 Retention in Care ........................................................22 Adherence ..................................................................23 Risk Reduction ............................................................23 Side Effects .................................................................24
Candidates for PrEP ...................................................... 7
HIV Testing .................................................................24
Box 2: Individuals Who Should Be Offered PreExposure Prophylaxis (PrEP) ............................... 8
Renal Function Testing ...............................................25 STI Screening ..............................................................25
Clinical Considerations With TDF/FTC or TAF/FTC as PrEP ........................................................................... 10
Hepatitis C Screening ..................................................26
Box 3: Important Clinical Considerations With TDF/FTC or TAF/FTC as PrEP ............................. 10
Discontinuing PrEP ..................................................... 28
Contraindications to PrEP Initiation ........................... 11 Pre-Prescription Counseling and Assessment ............. 11 Pre-Prescription Medical Evaluation and Laboratory Testing ....................................................................... 14 Table 2: Recommended Laboratory Tests to Be Obtained Before Prescribing TDF/FTC or TAF/FTC as PrEP .............................................................. 15 Prescribing PrEP ......................................................... 17 Preferred Regimen ..................................................... 17 Dosing Strategies........................................................ 17 Time to Protection ..................................................... 18 Monitoring and Ongoing Laboratory Testing .............. 20
Pregnancy Screening and Management .....................27 Managing a Positive HIV Test Result........................... 29 Suspected Acute HIV ..................................................30 Asymptomatic Patients With a Reactive HIV Screening Test Result ..................................................................30 Ambiguous Test Results .............................................31 All Recommendations ................................................ 43 All Good Practices ...................................................... 47 Appendices: PrEP Checklists ....................................... 48 Pre-Prescription Patient Evaluation Checklist ............48 Pre-Prescription Patient Education Checklist .............49 PrEP Management Checklist.......................................50 GOALS: A New Framework for Sexual History Taking in Primary Care ...............................................................52