Guidelines for HIV Pre-Exposure Prophylaxis in Females

Current PrEP Recommendations for Females

The American Medical Association recommends Tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) once daily as the oral PrEP regimen for all individuals at risk for HIV infection through sexual exposure, including females 1, 3, 4
Daily dosing is especially important for women, as tenofovir concentrates at 10-fold lower levels in vaginal tissue than in rectal tissue and clearance is faster 4
PrEP is recommended for populations with an HIV incidence above 2% per year and for HIV-seronegative partners of HIV-infected persons who are not consistently virally suppressed 4, 5

The Centers for Disease Control and Prevention recommends combined HIV antibody and antigen testing, serum creatinine level, hepatitis B surface antigen, hepatitis C IgG antibody, genital and nongenital Neisseria gonorrhea and Chlamydia trachomatis testing by nucleic acid amplification test (NAAT), and pregnancy testing for individuals of childbearing potential 2, 3
Quarterly monitoring should include combined HIV antibody and antigen test, estimated creatinine clearance rate, genital and nongenital gonorrhea and chlamydia testing by NAAT, syphilis testing, and pregnancy testing 2

PrEP prescriptions should not exceed 90 days without interval testing for HIV infection 4
Unlike condoms, PrEP does not prevent other sexually transmitted infections 4
For women who inject drugs, clean injection equipment and access to substance use treatment should be available 4

For females requiring PrEP, tenofovir disoproxil fumarate/emtricitabine remains the only recommended option with proven efficacy 1, 3, 4
Daily dosing is critical for females to maintain adequate drug levels in vaginal tissue 4
Regular monitoring for HIV, STIs, renal function, and pregnancy is essential 2