PrEP to limit the spread of HIV

By Chris Ferrin, PharmD

 

Pre-Exposure Prophylaxis or “PrEP” is the daily use of an oral antiretroviral to prevent HIV infection. PrEP is recommended by the CDC as one prevention option for men and women who are at substantial risk of HIV exposure and is an important tool to limit the spread of HIV.

CareOregon covers Truvada as the first-line medication for PrEP. You do not need to be an HIV or infectious disease specialist to prescribe PrEP therapy. The first step is an HIV risk assessment to determine whether PrEP is indicated. Once it is determined that a patient is at high risk for HIV, the CDC recommends the following be done before treatment is initiated:

  • Testing to confirm negative HIV status before prescribing PrEP
  • Documentation of no signs/symptoms of acute HIV infection
  • Renal function testing
  • Documentation of hepatitis B virus and vaccination status

It is important to remind patients that PrEP will not protect against other sexually transmitted infections (STI), and counseling on condom use and other STI risk reduction methods should be done at every visit. PrEP is not a complete HIV treatment regimen and should not be started or continued in a patient with active HIV as this can encourage resistance in the HIV virus. Adherence to therapy must also be continually enforced as PrEP only works if it is taken every day. Using PrEP on an “as needed” basis is NOT effective.

At a minimum, routine follow-up after initiation of PrEP should occur at 3-month intervals and the following should be done at each follow-up:

  • Testing to confirm the patient is still HIV negative
  • Medication adherence counseling and behavioral risk support
  • STI screening
  • Renal function testing (every 6 months after initial 3-month test)

The CDC website has numerous resources to assist with integrating PrEP prescribing into practice as well as substantial patient focused information.

PrEP Table