HIV PrEP Chart PDF

HIV Pre-Exposure Prophylaxis (PrEP) Based on the US Public Health Service Preexposure Prophylaxis for the Prevention of HIV Infection in the United States - 2021...

HIV Pre-Exposure Prophylaxis (PrEP) Based on the US Public Health Service Preexposure Prophylaxis for the Prevention of HIV Infection in the United States - 2021 More clinical pearls at pyrls.com Update: A Clinical Practice Guideline This chart does not provide guidance or recommendations for individuals who are pregnant Those who have had sex (vaginal or anal) HIV-positive sexual partner Inconsistent condom use One or more bacterial STI diagnosis in the past 6 months: in the past 6 months, (especially if viral load is (or non-use) with 1 or more MSM and TGW^: syphilis, gonorrhea or chlamydia plus one or more of detectable or unknown) partners of unknown HIV status Heterosexual men and women: syphilis or gonorrhea Who may be the following: eligible?* Those who have used * Patients may not feel comfortable discussing sexual or injectable drugs in the Shared injection HIV-positive injection behavior with healthcare providers. past 6 months, equipment with others injecting partner PrEP therapy should be offered to patients when requested plus one or more (needles, syringes, etc.) (even if no risk behavior is identified). of the following: Oral PrEP Intramuscular (IM) Cabotegravir Emtricitabine (FTC) 200 mg + Cabotegravir (CAB) 600 mg injection (Apretude) Tenofovir alafenamide (TAF) 25 mg (Descovy) For adults and adolescents (≥ 35 kg) For adults and adolescents (≥ 35 kg), Injections are administered by a healthcare provider except those at risk for HIV infection from receptive vaginal sex ⚬ May be given up to 7 days before or after the scheduled date Dosing: 1 tablet by mouth once daily Initial Dosing: two separate 600 mg IM gluteal injections Available each given 1 month apart regimens Maintenance Dosing: 600 mg IM injection every 2 months Emtricitabine (FTC) 200 mg + (after the two initial doses) Tenofovir disoproxil fumarate (TDF) 300 mg (Truvada) Optional oral lead-in to assess tolerability: Oral cabotegravir 30 mg by mouth once daily for 28 days, For adults and adolescents (≥ 35 kg) then the first IM injection on the last day of oral dose Dosing: 1 tablet by mouth once daily or within 3 days thereafter Negative HIV test (Ag/Ab) within 1 week before initiation required ⚬ Plus no signs/symptoms of acute HIV infection Negative HIV-1 RNA assay within 1 week before initiation required ⚬ Plus no signs/symptoms of acute HIV infection Hepatitis B serology STI screening: syphilis, gonorrhea and chlamydia Baseline Hepatitis C serology (MSM, TGW, PWID only) screening Renal function and ⚬ FTC + TDF: do not use if eCrCl < 60 mL/min IM cabotegravir may be preferable for patients with testing ⚬ FTC + TAF: do not use if eCrCl < 30 mL/min significant renal disease or in those who have Patients on FTC+TAF: weight, triglyceride and cholesterol levels adherence issues with daily oral regimens STI screening: syphilis, gonorrhea and chlamydia At least every 3 months* 1 month after the first injection HIV testing (Ag/Ab test and HIV-1 RNA assay) HIV testing (Ag/Ab test and HIV-1 RNA assay) Assess for signs/symptoms of acute HIV infection Assess for signs/symptoms of acute HIV infection Assess medication adherence and risk engagement behavior MSM and TGW^: screen for syphilis, gonorrhea and chlamydia Every 2 months (starting with the 3rd injection [month 3]) Every 6 months HIV testing (Ag/Ab test and HIV-1 RNA assay) Assess for signs/symptoms of acute HIV infection Assess renal function in: ⚬ Patients 50 years or older ⚬ Patients with eCrCl < 90 mL/min at baseline Every 4 months Follow-up (starting with the 3rd injection [month 3]) testing STI screening for all sexually active patients: ⚬ Heterosexual men and women: syphilis and gonorrhea MSM and TGW^: screen for syphilis, gonorrhea and chlamydia ⚬ MSM and TGW^: syphilis, gonorrhea and chlamydia Discuss continuation or discontinuation of PrEP therapy Every 6 months (starting with the 5th injection [month 7]) Every 12 months Heterosexual men and women: screen for syphilis and gonorrhea Assess renal function for all patients Every 12 months after 1st injection MSM, TGW and PWID: screen for hepatitis C Heterosexual men and women: screen for chlamydia Heterosexual men & women: screen for chlamydia Patients on FTC + TAF: assess weight, triglyceride and cholesterol Discuss continuation or discontinuation of PrEP therapy * All sexually active patients with signs/symptoms ^ TGW who have sex with men of STI(s) should receive appropriate testing If at any time during PrEP therapy the patient tests positive for HIV, the results should be confirmed with appropriate laboratory testing. If the positive result is confirmed, the patient should receive appropriate HIV treatment from a qualified provider. Abbreviations Ag/Ab: antigen/antibody FTC: emtricitabine PrEP: pre-exposure prophylaxis TAF: tenofovir alafenamide CAB: cabotegravir HIV: human immunodeficiency virus PWID: persons who inject drugs TDF: tenofovir disoproxil fumarate eCrCl: estimated creatinine clearance MSM: men who have sex with men STI: sexually transmitted infection TGW: transgender women Reference: Preexposure Prophylaxis for the Prevention of HIV Infection in the United States - - - - - - – 2021 Update Clinical Practice Guideline. US Public Health Service. 2021. ® 2023 Cosmas Health, Inc. and/or its affiliates. All rights reserved.