Fast Five Quiz: HIV Pre-exposure Prophylaxis: Selecting Appropriate Candidates

Jason F. Okulicz, MD


June 09, 2022

According to the Centers for Disease Control and Prevention (CDC), acute and chronic HIV must be excluded prior to the initiation of PrEP. To reduce the risk for drug resistance, PrEP should not be considered for individuals with signs or symptoms of acute viral infection and recent (< 1 month) exposure. Starting PrEP should be delayed for at least 1 month to reconfirm a negative HIV-1 status using an FDA-approved test.

Oral PrEP should not be used in individuals with severe kidney impairment. Tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) is approved for use in people with eCrCL ≥ 60 mL/min; tenofovir alafenamide/emtricitabine (TAF/FTC) is approved for use in people with eCrCL ≥ 30 mL/min. For patients with severe kidney disease, injectable PrEP with long-acting cabotegravir may be considered.

Pregnancy is not a contraindication for PrEP. Evidence suggests that there is no association with increased risk for adverse pregnancy or early infant growth outcomes with TDF/FTC PrEP; however, TAF/FTC is not indicated in individuals at risk for HIV from receptive vaginal sex because effectiveness in this population has not been evaluated.

The US Preventive Services Task Force recommends considering PrEP for use in individuals who had an STI with syphilis or gonorrhea within the past 6 months.

Learn more about the criteria for PrEP.


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