ID Board Review/Human Immunodeficiency Virus (HIV) Infection/HIV Prevention

Pre-Exposure Prophylaxis (PrEP)

• PrEP = Tenofovir + Emtricitabine
• Can reduce risk of HIV acquisition by >90%, and is offered to patients at risk for new HIV Infection

Indications for PrEP

• Sexual Behaviors:
  • Patients with HIV-positive partner with detectable viral load
  • Patients that are MSM
  • Patients from high prevalence areas (e.g. sub-Saharan Africa) have have had:
    • Recent bacterial STI(s)
    • Sex in exchange for money
    • Inconsistent condom use
    • High number of partners
• Injection Drug Use:
  • HIV-positive injecting partner
  • Sharing of injecting equipment

Contraindications to PrEP

• Active HIV infection
  • 2-drug antiretroviral therapy would incompletely treat active HIV, and cause drug resistance

PrEP Requirements

• Patients must have negative fourth-generation HIV testing and NO manifestations of acute HIV
• As well as normal renal function, and documented Hep B infection/vaccination
  • Patients with chronic HBV infection can sometimes undergo combined HBV and PrEP Treatment

PrEP Follow Up

• q 3 mo HIV testing, as well as
  • Risk-reduction counseling
  • Medication adherence/side-effect assessment
• Regular Cr levels and screen for bacterial STIs