Interim guidance for PrEP In MSM
CDC: Do not expand to other risk groups yet
The Centers for Disease Control and Prevention is developing formal guidelines on preexposure prophylaxis (PrEP) to prevent HIV in men who have sex with men (MSM). In the interim, the CDC has issued the following recommendations to guide clinical practice.1
Before initiating PrEP determine eligibility
- Document negative HIV antibody test(s) immediately before starting PrEP medication.
- Test for acute HIV infection if patient has symptoms consistent with acute HIV infection.
- Confirm that patient is at substantial, ongoing, high risk for acquiring HIV infection.
- Confirm that calculated creatinine clearance is ≥ 60 mL per minute (via Cockcroft-Gault formula).
Other recommended actions
- Screen for hepatitis B infection; vaccinate against hepatitis B if susceptible, or treat if active infection exists, regardless of decision about prescribing PrEP.
- Screen and treat as needed for STIs.
Beginning PrEP medication regimen
- Prescribe 1 tablet of Truvada (TDF [tenofovir disoproxil fumarate] [300 mg] plus FTC [emtricitabine] [200 mg]) daily.*
- In general, prescribe no more than a 90-day supply, renewable only after HIV testing confirms that patient remains HIV-uninfected.
- If active hepatitis B infection is diagnosed, consider using TDF/FTC for both treatment of active hepatitis B infection and HIV prevention.
- Provide risk-reduction and PrEP medication adherence counseling and condoms. Follow-up while PrEP medication is being taken.
- Every 2–3 months, perform an HIV antibody test; document negative result.
- Evaluate and support PrEP medication adherence at each follow-up visit, more often if inconsistent adherence is identified.
- Every 2–3 months, assess risk behaviors and provide risk-reduction counseling and condoms. Assess STI (sexually transmitted infection) symptoms and, if present, test and treat for STI as needed.
- Every 6 months, test for STI even if patient is asymptomatic, and treat as needed.
- Three months after initiation, then yearly while on PrEP medication, check blood urea nitrogen and serum creatinine.
On discontinuing PrEP (at patient request, for safety concerns, or if HIV infection is acquired)
- Perform HIV test(s) to confirm whether HIV infection has occurred.
- If HIV positive, order and document results of resistance testing and establish linkage to HIV care.
- If HIV negative, establish linkage to risk-reduction support services as indicated.
- If active hepatitis B is diagnosed at initiation of PrEP, consider appropriate medication for continued treatment of hepatitis B.
- These recommendations do not reflect current Food and Drug Administration-approved labeling for TDF/FTC.
Reference
- Centers for Disease Control and Prevention. Interim Guidance: Pre-exposure prophylaxis for the prevention of HIV infection in men who have sex with men. MMWR 2011;60:65-68.
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