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<sup>1</sup> Don’t start PrEP if eCrCl <60 mL/min. Recheck renal status at 3mo, then q6mo thereafter. D/C PrEP If renal failure detected [IIIA].<br><br>
<sup>2</sup> HBV infxn isn’t a contraindication to PrEP use. CDC recommends vaccinating all adults/adolescents at substantial risk for HIV infxn against HBV, especially MSM. Document HBV infxn status by screening serology before prescribing TDF/FTC. Vaccinate pts determined to be susceptible to HBV infxn. If pt is HBsAg positive, treat or refer to experienced HBV care provider.
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<sup>3</sup> Routinely take a sexual hx from ALL pts to identify which pts are having sex w/ same-sex partners/opposite-sex partners and what specific sexual behaviors may cause risk from/protect against HIV acquisition.<br><br>
• <b>Transgender persons</b> - Although effectiveness of PrEP for transgender women hasn't yet been definitively proven in trials, and trials haven't been conducted among transgender men, PrEP has been shown to reduce risk for HIV acquisition during anal sex and penile-vaginal sex.
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• <b>Heterosexual men and women/PWID</b> – No data exist on regimen effectiveness for heterosexual men and women and PWID.
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<sup>4</sup> Use of antiretrovirals other than TDF/FTC (or TDF) is <b>not</b> recommended [IIIA], incl 3TC, TAF, either in place of, or in addition to TDF/FTC or TDF. Prescription of oral PrEP for coitally timed or other noncontinuous daily use is <b>not</b> recommended [IIIA].
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<sup>5</sup> Document a negative Ab test result w/in the wk before initiating (or reinitiating) PrEP meds, ideally w/ an Ag/Ab test conducted by a lab whenever available.<br><br>
Two options:<br>
1) Draw blood (serum) and send specimen to lab for Ag/Ab test or Ab-only test OR<br>
2) perform rapid, point-of-care FDA-approved fingerstick blood test.<br><br>
Don’t use rapid tests that use oral fluids to screen for HIV infxn as they can be less sensitive than blood tests.<br><br>
Note: If using viral load testing, be aware that available assays might yield false positive low viral load results (<3,000 copies/mL) among persons w/o HIV infxn.
<br><br>
See <a href=http://www.cdc.gov/hiv/testing/laboratorytests.html><b><u>FDA-approved HIV tests</u></b></a>, specimen requirements, and time to detection of HIV infxn.
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<sup>6</sup> If pregnancy desired, follow guidance for serodiscordant couples at time of conception/preg.
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<sup>7</sup> TDF/FTC alone is inadequate tx for established HIV infxn, & its use may lead to drug resistance [IA].
<sup>2</sup> HBV infxn isn’t a contraindication to PrEP use. CDC recommends vaccinating all adults/adolescents at substantial risk for HIV infxn against HBV, especially MSM. Document HBV infxn status by screening serology before prescribing TDF/FTC. Vaccinate pts determined to be susceptible to HBV infxn. If pt is HBsAg positive, treat or refer to experienced HBV care provider.
<br><br>
<sup>3</sup> Routinely take a sexual hx from ALL pts to identify which pts are having sex w/ same-sex partners/opposite-sex partners and what specific sexual behaviors may cause risk from/protect against HIV acquisition.<br><br>
• <b>Transgender persons</b> - Although effectiveness of PrEP for transgender women hasn't yet been definitively proven in trials, and trials haven't been conducted among transgender men, PrEP has been shown to reduce risk for HIV acquisition during anal sex and penile-vaginal sex.
<br><br>
• <b>Heterosexual men and women/PWID</b> – No data exist on regimen effectiveness for heterosexual men and women and PWID.
<br><br>
<sup>4</sup> Use of antiretrovirals other than TDF/FTC (or TDF) is <b>not</b> recommended [IIIA], incl 3TC, TAF, either in place of, or in addition to TDF/FTC or TDF. Prescription of oral PrEP for coitally timed or other noncontinuous daily use is <b>not</b> recommended [IIIA].
<br><br>
<sup>5</sup> Document a negative Ab test result w/in the wk before initiating (or reinitiating) PrEP meds, ideally w/ an Ag/Ab test conducted by a lab whenever available.<br><br>
Two options:<br>
1) Draw blood (serum) and send specimen to lab for Ag/Ab test or Ab-only test OR<br>
2) perform rapid, point-of-care FDA-approved fingerstick blood test.<br><br>
Don’t use rapid tests that use oral fluids to screen for HIV infxn as they can be less sensitive than blood tests.<br><br>
Note: If using viral load testing, be aware that available assays might yield false positive low viral load results (<3,000 copies/mL) among persons w/o HIV infxn.
<br><br>
See <a href=http://www.cdc.gov/hiv/testing/laboratorytests.html><b><u>FDA-approved HIV tests</u></b></a>, specimen requirements, and time to detection of HIV infxn.
<br><br>
<sup>6</sup> If pregnancy desired, follow guidance for serodiscordant couples at time of conception/preg.
<br><br>
<sup>7</sup> TDF/FTC alone is inadequate tx for established HIV infxn, & its use may lead to drug resistance [IA].
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Risk Criteria: HIV+ partner, recent (w/in 6mo) bacterial STI (syphilis, gonorrhea, or chlamydia), high # of partners, inconsistent/no condom use, commercial sex work, in high-prevalence area, HIV+ injecting partner, sharing injxn equip