Pre-Exposure Prophylaxis for HIV Prevention

First-Line PrEP Options

The American College of Physicians recommends daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) as the standard PrEP regimen with proven efficacy across all risk groups 1, 2
For men who have sex with men (MSM), a double dose of TDF/FTC is recommended on the first day, followed by daily dosing 2
Daily dosing should be maintained for continued protection, with dosing to continue until 2 doses after last sexual activity for rectal exposures 1
For vaginal, neovaginal, or "front-hole" exposures, dosing should continue until at least 7 days after last sexual activity 1
On-demand (2-1-1) oral dosing of TDF/FTC is an alternative option for cisgender men and others having planned receptive anal sex 1
Injectable cabotegravir every 8 weeks is recommended (pending regulatory approval and availability) 2
For those with or at risk for kidney dysfunction, osteopenia, or osteoporosis, daily tenofovir alafenamide/emtricitabine (TAF/FTC) is recommended 2, 3

Before starting PrEP, the following tests should be performed: combined HIV antibody and antigen testing, serum creatinine level, estimated creatinine clearance, hepatitis B surface antigen, hepatitis C IgG antibody, genital and nongenital Neisseria gonorrhea and Chlamydia trachomatis testing, and pregnancy testing for individuals of childbearing potential 1, 2, 4

HIV testing at 1 month and quarterly thereafter 3
Creatinine clearance at first quarterly visit and annually thereafter 3
STI testing quarterly 3, 4
PrEP prescriptions should not exceed 90 days without interval testing for HIV infection 4

PrEP is safe for use during pregnancy and breastfeeding, with TDF/FTC being the recommended regimen 1
Long-acting cabotegravir has a growing safety profile in pregnancy and breastfeeding 1
For MSM with renal impairment or bone health concerns, TAF/FTC is preferred over TDF/FTC 3
PrEP should be discussed and offered to all sexually active persons, all persons requesting PrEP, and anyone who injects nonprescription drugs or uses substances, without limiting access based on specific criteria for sexual or drug use behavior 1