{"id":396,"date":"2021-06-06T03:46:00","date_gmt":"2021-06-06T03:46:00","guid":{"rendered":"https:\/\/obgconnectdev.wpengine.com\/curbside\/?p=396"},"modified":"2025-02-27T15:17:18","modified_gmt":"2025-02-27T15:17:18","slug":"hiv-pre-exposure-prophylaxis-prep-who-its-for-and-why-how-it-works","status":"publish","type":"post","link":"https:\/\/obgconnect.com\/curbside\/2021\/06\/06\/hiv-pre-exposure-prophylaxis-prep-who-its-for-and-why-how-it-works\/","title":{"rendered":"HIV Pre-Exposure Prophylaxis (PrEP) &#8211; Who&#8217;s it for?"},"content":{"rendered":"<h4 class=\"wp-block-heading\"><a href=\"https:\/\/obgconnect.com\/curbside\/2021\/06\/07\/sexual-history-taking-101-how-do-i-start-the-conversation-with-my-patients\/\">Sexual History Taking 101: How Do I Start the Conversation with My Patients?<\/a> |&#xA0;HIV Pre-Exposure Prophylaxis (PrEP) &#x2013; Who&#x2019;s it for?&#xA0;|&#xA0;<a href=\"https:\/\/obgconnect.com\/curbside\/2021\/06\/05\/initial-visit-dosing-and-follow-up\/\">Initial Visit, Dosing, and Follow Up<\/a>&#xA0;&#xA0;|&#xA0;<a href=\"https:\/\/obgconnect.com\/curbside\/2021\/06\/04\/the-prep-guidelines-center\/\">The PrEP Guidelines Center<\/a>&#xA0;|&#xA0;<a href=\"https:\/\/obgconnect.com\/curbside\/2021\/06\/03\/implement-and-maintain-a-prep-program-in-your-clinic\/\">Implement and Maintain a PrEP Program in Your Clinic<\/a> | <a href=\"https:\/\/obgconnect.com\/curbside\/2021\/06\/01\/downloadable-infographics\/\">Downloadable Infographics<\/a><\/h4>\n\n\n\n<h2 class=\"wp-block-heading\">Review the latest recommendations with <\/h2>\n\n\n\n<p><strong>Jonathan Shuter, MD<\/strong>, a Professor of Medicine in the Division of Infectious Diseases at Montefiore Medical Center and the Albert Einstein College of Medicine<\/p>\n\n\n\n<p><strong>Uriel Felsen, MD<\/strong>, an Associate Professor of Medicine in the Division of Infectious Diseases at Montefiore Medical Center and the Albert Einstein College of Medicine<\/p>\n\n\n\n<p><strong>Raffaele M. Bernardo, DO<\/strong>, an Assistant Professor of Medicine in the Division of Infectious Diseases at Montefiore Medical Center and the Albert Einstein College of Medicine<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">SUMMARY:<\/h2>\n\n\n\n<p>There are now three types of PrEP approved by the Food and Drug Administration (<span class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;FDA&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;U.S. Food and Drug Administration&lt;\/div&gt;\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">FDA<\/span>) currently available &#x2013; oral formulations (Truvada and Descovy) and an intramuscular injection, cabotegravir. All treatments work by stopping the HIV replication process. While HIV PrEP is recommended for all individuals that it is applicable for, at this time, <em>Descovy is not approved for the prevention of HIV for those at risk through receptive vaginal sex &#x2013; including cisgender women, transgender men, and others<\/em>.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Truvada<\/strong> <em>brand name<\/em> (Emtricitabine (F) 200mg with tenofovir disoproxil fumarate (TDF) 300mg) daily<\/li>\n\n\n\n<li><strong>Descovy<\/strong> <em>brand name<\/em> (Emtricitabine (F) 200mg with tenofovir alafenamide (TAF) 25mg) daily<\/li>\n\n\n\n<li><strong>Vocabria<\/strong> <em>brand name <\/em>(Cabotegravir 600mg) gluteal IM injection at month zero, month one, then every two months<\/li>\n<\/ul>\n\n\n\n<p>Of note, we refer to Truvada as F\/TDF, Descovy as F\/TAF, and Vocabria as Cabotegravir throughout<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">BACKGROUND:<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Providing Pre-exposure Prophylaxis<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Goal of PrEP is to reduce the acquisition of HIV and its subsequent costs to individuals and society<\/li>\n\n\n\n<li>PrEP has been a part of the HIV prevention landscape since 2012<\/li>\n\n\n\n<li><span style=\"color: initial;, sans-serif\">Both HIV PrEP oral tablets contain two antiretroviral medications called nucleoside reverse transcriptase inhibitors (NRTIs)<\/span>\n<ul class=\"wp-block-list\">\n<li>These medications work by inhibiting the enzyme reverse transcriptase that HIV needs to replicate<\/li>\n\n\n\n<li>Both tablets are used in many common HIV treatment regimens<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>The intramuscular injection contains an integrase strand-transfer inhibitor (INSTI) which works by inhibiting the enzyme that HIV uses to integrate its own <span class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;DNA&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;The DNA molecule consists of two strands that wind around one another to form a shape known as a double helix. Each strand has a backbone made of alternating sugar (deoxyribose) and phosphate groups. Attached to each sugar is one of four bases--adenine (A), cytosine (C), guanine (G), and thymine (T). The two strands are held together by bonds between the bases; adenine bonds with thymine, and cytosine bonds with guanine. The sequence of the bases along the backbones serves as instructions for assembling protein and RNA molecules. (NIH: National Human Genome Research Institute)&amp;lt;br \/&amp;gt;&amp;lt;img class=&amp;quot;alignnone wp-image-445&amp;quot; src=&amp;quot;http:\/\/obgprojectdev.wpengine.com\/wp-content\/uploads\/2016\/07\/dna-300x120.png&amp;quot; alt=&amp;quot;dna&amp;quot; width=&amp;quot;223&amp;quot; height=&amp;quot;89&amp;quot; \/&amp;gt;&lt;\/div&gt;\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">DNA<\/span> into the CD4 cell&#x2019;s nucleic <span class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;DNA&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;The DNA molecule consists of two strands that wind around one another to form a shape known as a double helix. Each strand has a backbone made of alternating sugar (deoxyribose) and phosphate groups. Attached to each sugar is one of four bases--adenine (A), cytosine (C), guanine (G), and thymine (T). The two strands are held together by bonds between the bases; adenine bonds with thymine, and cytosine bonds with guanine. The sequence of the bases along the backbones serves as instructions for assembling protein and RNA molecules. (NIH: National Human Genome Research Institute)&amp;lt;br \/&amp;gt;&amp;lt;img class=&amp;quot;alignnone wp-image-445&amp;quot; src=&amp;quot;http:\/\/obgprojectdev.wpengine.com\/wp-content\/uploads\/2016\/07\/dna-300x120.png&amp;quot; alt=&amp;quot;dna&amp;quot; width=&amp;quot;223&amp;quot; height=&amp;quot;89&amp;quot; \/&amp;gt;&lt;\/div&gt;\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">DNA<\/span><\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Oral PrEP medications<\/h3>\n\n\n\n<p><em><span class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;FDA&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;U.S. Food and Drug Administration&lt;\/div&gt;\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">FDA<\/span> Approved Regimens:<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Truvada | Emtricitabine (F) 200mg and tenofovir disoproxil (TDF) 300mg) | one tablet orally daily, with or without food<\/li>\n\n\n\n<li>Descovy | Emtricitabine (F) 200mg and tenofovir alafenamid (TAF) 25mg) | one tablet orally daily, with or without food<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Alternative formulations of PrEP medications<\/h3>\n\n\n\n<p>Cabotegravir<span style=\"font-size: revert;color: initial;, sans-serif\"> 600mg gluteal IM injection was granted <span class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;FDA&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;U.S. Food and Drug Administration&lt;\/div&gt;\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">FDA<\/span> approval in December 2021<\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Requires IM injection at month zero, month one, then every two months afterwards<\/li>\n\n\n\n<li>One three mL injection in the gluteal muscle<\/li>\n\n\n\n<li>Only available for HIV negative patients without contra-indications to the medication<\/li>\n<\/ul>\n\n\n\n<p>What many clinicians wonder next is &#x201C;What patients would be good candidates for PrEP?&#x201D; PrEP is a sexual health option for people interested in HIV prevention and could be appropriate for many patients you see on a daily basis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Who It&#x2019;s For &#x2013; CDC Guidance and Other Considerations<\/h3>\n\n\n\n<p>The&#xA0;<span class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;CDC&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;Centers for Disease Control and Prevention&lt;\/div&gt;\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">CDC<\/span> recently updated guidance to recommend routine counseling of risks of transmission of HIV and PrEP options as well as routine prescribing of PrEP to appropriate candidates. &#xA0;Now, discussion of PrEP is recommended for all individuals who are sexually active.<\/p>\n\n\n\n<p>Although &#x201C;risk groups&#x201D; have been defined by the&#xA0;<span class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;CDC&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;Centers for Disease Control and Prevention&lt;\/div&gt;\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">CDC<\/span>, we caution the idea of patients as levels of &#x201C;risk,&#x201D; particularly when it comes to sexual health. What it involves is taking a good sexual history and documenting what behavioral choices they make, then offering PrEP as an option for HIV prevention.<\/p>\n\n\n\n<p><em>PrEP is for people without HIV who could be exposed to HIV from sex or injection drug use<\/em>. <\/p>\n\n\n\n<p>The <span class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;CDC&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;Centers for Disease Control and Prevention&lt;\/div&gt;\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">CDC<\/span> provides the following recommendations:<\/p>\n\n\n\n<div class=\"wp-block-group\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p><span class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;CDC&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;Centers for Disease Control and Prevention&lt;\/div&gt;\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">CDC<\/span> recommends the following patients should be assessed for PrEP including<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sexually active gay and bisexual men without HIV<\/li>\n\n\n\n<li>Sexually active heterosexual men and women without HIV<\/li>\n\n\n\n<li>Sexually active transgender persons without HIV<\/li>\n\n\n\n<li>Persons without HIV who inject drugs<\/li>\n\n\n\n<li>Persons who have been prescribed non-occupational post-exposure prophylaxis (PEP) and report behaviors that could expose them to HIV, or who have used multiple courses of PEP<\/li>\n<\/ul>\n\n\n\n<p>For sexually active adults and adolescents:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Anal or vaginal sex in the past six months; <strong>and<\/strong><\/li>\n\n\n\n<li>HIV-positive sexual partner (especially if partner has unknown or detectable viral load);&#xA0;<strong>or<\/strong><\/li>\n\n\n\n<li>Recent bacterial STI; <strong>or<\/strong><\/li>\n\n\n\n<li>History of inconsistent or no condom use with sexual partner(s)<\/li>\n<\/ul>\n\n\n\n<p>For Persons who inject drugs:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>HIV-positive injecting partner;&#xA0;<strong>or<\/strong><\/li>\n\n\n\n<li>Shares drug preparation or injection equipment<\/li>\n<\/ul>\n\n\n\n<p>All persons eligible for PrEP:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Documented negative HIV test result before prescribing PrEP;&#xA0;<strong>and<\/strong><\/li>\n\n\n\n<li>No signs\/symptoms of acute HIV infection;&#xA0;<strong>and<\/strong><\/li>\n\n\n\n<li>Normal renal function;&#xA0;<strong>and<\/strong><\/li>\n\n\n\n<li>No contraindicated medications<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\">\n\n\n\n<p><strong>NOTE:<\/strong> While the <span class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;CDC&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;Centers for Disease Control and Prevention&lt;\/div&gt;\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">CDC<\/span> compartmentalizes &#x201C;risk groups&#x201D; as listed above, as clinicians we must remember that sexual health does not fit neatly into static compartments. Sexuality and sexual behavior are fluid, and individuals may change their partners, behavior, and condom use over time and situation &#x2013; and invite us to explain in detail<\/p>\n\n\n\n<p>Thus, the <span class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;CDC&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;Centers for Disease Control and Prevention&lt;\/div&gt;\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">CDC<\/span> guidance is exactly what it is &#x2013; guidance. Nothing replaces taking a good sexual history to discover which patients may be good candidates for PrEP. <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Individuals who do not fit in the categories mentioned above could still benefit from PrEP &#x2013; so be sure not to limit offering PrEP to just certain groups of people<\/li>\n\n\n\n<li>Anyone who is sexually active could be a candidate for PrEP.<\/li>\n\n\n\n<li>Patients who ask for PrEP may not feel comfortable sharing all their sexual behavior with medical providers due to fear of judgment and stigma<\/li>\n\n\n\n<li>If a patient comes into your office inquiring about PrEP, even if they don&#x2019;t verbally describe specific behaviors that the <span class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;CDC&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;Centers for Disease Control and Prevention&lt;\/div&gt;\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">CDC<\/span> defines as &#x201C;risky,&#x201D; they are asking for a reason<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-css-opacity\">\n\n\n\n<h3 class=\"wp-block-heading\">Dosage Regimen<\/h3>\n\n\n\n<p>These medications are approved to prevent HIV infection in adults and adolescents weighing at least 35 kg (77 lb) as follows:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Daily oral PrEP with F\/TDF (Truvada) is recommended to prevent HIV infection among all persons at risk through sex or injection drug use.<\/li>\n\n\n\n<li>Daily oral PrEP with F\/TAF (Descovy) is recommended to prevent HIV infection among persons at risk through sex, excluding<strong><em>&#xA0;people at risk through receptive vaginal sex<\/em><\/strong>. F\/TAF has not yet been studied for HIV prevention for receptive vaginal sex.<\/li>\n<\/ul>\n\n\n\n<p><em>Selecting a Regimen<\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Determination of which oral regimen is appropriate depends on a patient&#x2019;s clinical status, comorbidities, as well as potential side effects and medication interactions\n<ul class=\"wp-block-list\">\n<li>Both F\/TDF and F\/TAF are equally effective in reducing HIV transmission&#xA0;<\/li>\n\n\n\n<li>F\/TDF (Truvada) is the only FDA-approved&#xA0;PrEP&#xA0;option for cis women who have receptive vaginal sex | May be better for people with a history of hypercholesterolemia&#xA0;<\/li>\n\n\n\n<li>F\/TAF (Descovy) is FDA-approved for use by transgender women, transgender men, and MSM | the best option for persons with osteoporosis and can be used for patients with chronic kidney disease with a&#xA0;CrCl&#xA0;as low as 30 ml\/min&#xA0;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Comorbidities\n<ul class=\"wp-block-list\">\n<li>Hepatitis B&#xA0;<\/li>\n\n\n\n<li>HIV&#xA0;<\/li>\n\n\n\n<li>Renal disease&#xA0;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Common side effects\n<ul class=\"wp-block-list\">\n<li>The majority of people experience no side effects at all<\/li>\n\n\n\n<li>Mild to moderate gastritis at start of med course- usually tapers within three to four weeks | Can sometimes include diarrhea<\/li>\n\n\n\n<li>Headaches&#xA0;<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Medication interactions\n<ul class=\"wp-block-list\">\n<li>Other drugs that could affect renal function may require closer renal&#xA0;function&#xA0;while&#xA0;PrEP&#xA0;is being used<\/li>\n\n\n\n<li>Other antiviral medications can impact&#xA0;PrEP&#xA0;response and need to be reviewed with clinical use on a&#xA0;case by case&#xA0;basis<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p>&#x201C;<em>On-demand&#x201D; PrEP<\/em><\/p>\n\n\n\n<p>&#x201C;On-demand&#x201D; PrEP is not currently FDA-approved for use in the United States but many clinicians many use it in an &#x201C;off-label&#x201D; manner as appropriate with the needs of their patients and reflective of the studies in Europe that demonstrate its effectiveness in reducing HIV transmission.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Would be an option for people who may not engage in sex regularly or plan sexual encounters&#xA0;<\/li>\n\n\n\n<li>Involves the following regimen schedule for TDF\/FTC only\n<ul class=\"wp-block-list\">\n<li>Take two tablets at least two hours and not more than 24 hours before sex<\/li>\n\n\n\n<li>Take one tablet 24 hours after first two pills taken<\/li>\n\n\n\n<li>Take one tablet 48 hours after first two pills taken<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">PrEP Safety and Efficacy<\/h3>\n\n\n\n<p>PrEP, when used as indicated, has been determined to be safe and effective in the prevention of HIV transmission among diverse populations, including<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Men who have sex with men and transgender women: 85 &#x2013; 100% risk reduction&#xA0;<\/li>\n\n\n\n<li>Heterosexual women and men: 63 &#x2013; 90% risk reduction&#xA0;<\/li>\n\n\n\n<li>Persons who Inject Drugs (PWID) regardless of sexual activity: 73.5% risk reduction&#xA0;<\/li>\n\n\n\n<li>Adolescents who weigh over 35kg: &gt;95% risk reduction<\/li>\n<\/ul>\n\n\n\n<p><em>Clinical considerations with initiation<\/em><em><\/em><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Consider sexual health needs beyond HIV prevention- PrEP only offers prevention for HIV, not other STIs<\/li>\n\n\n\n<li>These medications must be monitored closely for patients with chronic active Hepatitis B (persistent positive Hepatitis B Surface Antigen)<\/li>\n\n\n\n<li>These medications require healthy kidney function (eCrCl &gt;60 ml\/min for TDF\/FTC and eCrCl &gt;30 ml\/min for TAF\/FTC)<\/li>\n\n\n\n<li>Can be prescribed by primary care providers without requiring infectious disease specialist or consult prior to initiation [for more information see<em> Initial Visit, Dosing, and Follow Up<\/em> or <em>Implement and Maintain a Prep Clinic<\/em> in the Resource Center<\/li>\n\n\n\n<li>Cabotegravir, the intramuscular injection pending <span class=\"glossaryLink\" aria-describedby=\"tt\" data-cmtooltip=\"&lt;div class=glossaryItemTitle&gt;FDA&lt;\/div&gt;&lt;div class=glossaryItemBody&gt;U.S. Food and Drug Administration&lt;\/div&gt;\" data-mobile-support=\"0\" data-gt-translate-attributes='[{\"attribute\":\"data-cmtooltip\", \"format\":\"html\"}]' tabindex=\"0\" role=\"link\">FDA<\/span> approval, can be used individuals without requiring creatinine or renal clearance, Hepatitis B status, lipid panels, or liver function tests<\/li>\n\n\n\n<li>Cabotegravir may be a better option for individuals who prefer injections every two months, have poor adherence with daily medication, or have other co-morbidities such as renal or liver disease<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Learn More &#x2013; Primary Sources:<\/h2>\n\n\n\n<p><a href=\"https:\/\/www.cdc.gov\/hivnexus\/hcp\/index.html\" target=\"_blank\" rel=\"noreferrer noopener\">CDC Pre-Exposure Prophylaxis for HIV Prevention<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/doi.org\/10.1542\/peds.2019-1743\" target=\"_blank\" rel=\"noreferrer noopener\">PrEP&#xA0;and Adolescents: The Role of Providers in Ending the AIDS Epidemic&#xA0;(Hosek&#xA0;et al.&#xA0;<em>Pediatrics<\/em>,&#xA0;2020)&#xA0;<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22972843\/\" target=\"_blank\" rel=\"noreferrer noopener\">Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men&#xA0;(Anderson et al.&#xA0;<em>Sci&#xA0;Transl&#xA0;Med<\/em>,&#xA0;2012)&#xA0;<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/22784037\/\" target=\"_blank\" rel=\"noreferrer noopener\">Antiretroviral prophylaxis for HIV prevention in heterosexual men and women&#xA0;(Baeten&#xA0;et al,&#x202F;<em>N&#xA0;Engl&#xA0;J Med<\/em>,&#xA0;2012)&#xA0;<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/23769234\/\" target=\"_blank\" rel=\"noreferrer noopener\">Bangkok Tenofovir Study Group. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a&#xA0;randomised, double-blind, placebo-controlled phase 3 trial&#xA0;(Choopanya&#xA0;et al.&#xA0;<em>Lancet<\/em>,&#xA0;2013)&#xA0;<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32711800\/\" target=\"_blank\" rel=\"noreferrer noopener\">Emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV pre-exposure prophylaxis (DISCOVER): primary results from a&#xA0;randomised, double-blind,&#xA0;multicentre, active-controlled, phase 3, non-inferiority trial&#xA0;(Mayer et al,&#x202F;<em>The Lancet<\/em>&#x202F;2020)&#xA0;<\/a><\/p>\n\n\n\n<p><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Commercial Support<\/h3>\n\n\n\n<p>This educational activity is supported by an independent educational grant from Gilead Sciences<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Faculty Disclosures<\/h3>\n\n\n\n<p>Dr. Shuter has no relevant financial relationships to disclose<\/p>\n\n\n\n<p>Dr. Felsen has no relevant financial relationships to disclose<\/p>\n\n\n\n<p>Dr. Bernardo has no relevant financial relationships to disclose<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Special Thanks <\/h3>\n\n\n\n<p>Special thanks to David Malebranche, MD, MPH and Ariel&#xA0;Watriss, MSN, NP for their insights and contribution.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Sexual History Taking 101: How Do I Start the Conversation with My Patients? |&nbsp;HIV Pre-Exposure Prophylaxis (PrEP) \u2013 Who\u2019s it for?&nbsp;|&nbsp;Initial Visit, Dosing, and Follow Up&nbsp;&nbsp;|&nbsp;The PrEP Guidelines Center&nbsp;|&nbsp;Implement and Maintain a PrEP Program in Your Clinic | Downloadable Infographics Review the latest recommendations with Jonathan Shuter, MD, a Professor of Medicine in the Division [&hellip;]<\/p>\n","protected":false},"author":1252,"featured_media":456,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[8],"tags":[],"class_list":["post-396","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-prepresource"],"acf":[],"featured_image_urls_v2":{"full":["https:\/\/obgconnect.com\/curbside\/wp-content\/uploads\/sites\/4\/2021\/07\/ondrej-bocek-_h9nJNZiyr0-unsplash-featured.jpg",400,265,false],"thumbnail":["https:\/\/obgconnect.com\/curbside\/wp-content\/uploads\/sites\/4\/2021\/07\/ondrej-bocek-_h9nJNZiyr0-unsplash-featured-150x150.jpg",150,150,true],"medium":["https:\/\/obgconnect.com\/curbside\/wp-content\/uploads\/sites\/4\/2021\/07\/ondrej-bocek-_h9nJNZiyr0-unsplash-featured-300x199.jpg",300,199,true],"medium_large":["https:\/\/obgconnect.com\/curbside\/wp-content\/uploads\/sites\/4\/2021\/07\/ondrej-bocek-_h9nJNZiyr0-unsplash-featured.jpg",400,265,false],"large":["https:\/\/obgconnect.com\/curbside\/wp-content\/uploads\/sites\/4\/2021\/07\/ondrej-bocek-_h9nJNZiyr0-unsplash-featured.jpg",400,265,false],"1536x1536":["https:\/\/obgconnect.com\/curbside\/wp-content\/uploads\/sites\/4\/2021\/07\/ondrej-bocek-_h9nJNZiyr0-unsplash-featured.jpg",400,265,false],"2048x2048":["https:\/\/obgconnect.com\/curbside\/wp-content\/uploads\/sites\/4\/2021\/07\/ondrej-bocek-_h9nJNZiyr0-unsplash-featured.jpg",400,265,false],"ultp_layout_landscape_large":["https:\/\/obgconnect.com\/curbside\/wp-content\/uploads\/sites\/4\/2021\/07\/ondrej-bocek-_h9nJNZiyr0-unsplash-featured.jpg",400,265,false],"ultp_layout_landscape":["https:\/\/obgconnect.com\/curbside\/wp-content\/uploads\/sites\/4\/2021\/07\/ondrej-bocek-_h9nJNZiyr0-unsplash-featured.jpg",400,265,false],"ultp_layout_portrait":["https:\/\/obgconnect.com\/curbside\/wp-content\/uploads\/sites\/4\/2021\/07\/ondrej-bocek-_h9nJNZiyr0-unsplash-featured.jpg",400,265,false],"ultp_layout_square":["https:\/\/obgconnect.com\/curbside\/wp-content\/uploads\/sites\/4\/2021\/07\/ondrej-bocek-_h9nJNZiyr0-unsplash-featured.jpg",400,265,false],"woocommerce_thumbnail":["https:\/\/obgconnect.com\/curbside\/wp-content\/uploads\/sites\/4\/2021\/07\/ondrej-bocek-_h9nJNZiyr0-unsplash-featured.jpg",300,199,false],"woocommerce_single":["https:\/\/obgconnect.com\/curbside\/wp-content\/uploads\/sites\/4\/2021\/07\/ondrej-bocek-_h9nJNZiyr0-unsplash-featured.jpg",400,265,false],"woocommerce_gallery_thumbnail":["https:\/\/obgconnect.com\/curbside\/wp-content\/uploads\/sites\/4\/2021\/07\/ondrej-bocek-_h9nJNZiyr0-unsplash-featured-100x100.jpg",100,100,true]},"post_excerpt_stackable_v2":"<p>Sexual History Taking 101: How Do I Start the Conversation with My Patients? |&#xA0;HIV Pre-Exposure Prophylaxis (PrEP) &#x2013; Who&#x2019;s it for?&#xA0;|&#xA0;Initial Visit, Dosing, and Follow Up&#xA0;&#xA0;|&#xA0;The PrEP Guidelines Center&#xA0;|&#xA0;Implement and Maintain a PrEP Program in Your Clinic | Downloadable Infographics Review the latest recommendations with Jonathan Shuter, MD, a Professor of Medicine in the Division of Infectious Diseases at Montefiore Medical Center and the Albert Einstein College of Medicine Uriel Felsen, MD, an Associate Professor of Medicine in the Division of Infectious Diseases at Montefiore Medical Center and the Albert Einstein College of Medicine Raffaele M. Bernardo, DO, an Assistant&hellip;<\/p>\n","category_list_v2":"<a href=\"https:\/\/obgconnect.com\/curbside\/category\/curbside\/prepresource\/\" rel=\"category tag\">PrEP Resource Center<\/a>","author_info_v2":{"name":"jcomfort","url":"https:\/\/obgconnect.com\/curbside\/author\/jcomfort\/"},"comments_num_v2":"0 comments","yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>HIV Pre-Exposure Prophylaxis (PrEP) - Who&#039;s it for? - Curbside Consult<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/obgconnect.com\/curbside\/2021\/06\/06\/hiv-pre-exposure-prophylaxis-prep-who-its-for-and-why-how-it-works\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"HIV Pre-Exposure Prophylaxis (PrEP) - Who&#039;s it for? 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