…but how do I provide PrEP?
Laboratory work needed
Labs to order:
HIV Ag/Ab to confirm patient is HIV-1 negative
HIV viral load
Renal function
Use of rapid HIV testing: PrEP can be started same day based off rapid HIV testing, but you need to also get a standard test and be able to contact the patient with results of that.
Consider HBV - However this test should not prevent starting PrEP.
Lipid profile every 12 months for DESCOVY
Clinical guidance
Is the Patient Clinically Eligible?
Documented negative HIV Ag/Ab test result within 1 week before initially prescribing PrEP
No signs/symptoms of acute HIV infection
Estimated creatine clearance > 30ml/min (Descovy) OR > 60ml/min (Truvada)
If renal impaired see below for additional dosing information
Oral FDA Approved Forms of PrEP:
Descovy - Dose 200mg/25mg taken daily
Most common side effects: Diarrhea
Truvada - Dose 200mg/300mg taken daily (Note a generic form is available)
Most common side effects: Headache, abdominal pain and weight loss
Injectable FDA Approved Form of PrEP:
Apretude (cabotegravier or CAB) - Dose 600mg administered every 2 months
Most common side effect: Injection site pain
This form of PrEP may be a good option for people who:
Have problems taking oral PrEP as prescribed.
Prefer getting a shot every 2 months instead of taking oral PrEP.
Have serious kidney disease that prevents use of oral PrEP medications.
SPecial considerations: Renal Imparement
Oral Dosing Considerations for Those with Renal Impairment:
-
CrCl <30 mL/min: Use is not recommended.
FTC:
CrCl 30 to 49 mL/min: 200 mg every 48 hours.
CrCl 15 to 29 mL/min: 200 mg every 72 hours.
CrCl <15 mL/min: 200 mg every 96 hours.
TAF:
CrCl <15 mL/min, without Hemodialysis: Use is not recommended.
CrCl <15 mL/min, with Hemodialysis: No renal dose adjustment is needed.
-
CrCl <30 mL/min: Use is not recommended.
CrCl 30 to 49 mL/min: FTC 200 mg/TDF 300 mg every 48 hours.
FTC:
CrCl 30 to 49 mL/min: 200 mg every 48 hours.
CrCl 15 to 29 mL/min: 200 mg every 72 hours.
CrCl <15 mL/min: 200 mg every 96 hours.
TDF:
CrCl 30 to 49 mL/min: 300 mg every 48 hours.
CrCl 10 to 29 mL/min: 300 mg every 72 to 96 hours.
CrCl <10 mL/min, without HD:No data available.
CrCl <10 mL/min, with HD: 300 mg every 7 days.
AKA NON-DAILY DOSING:
Alternative dosing (AKA “on-demand” or “event-driven”) can be used for biologic men and transgender women using a 2-1-1 dosing:
2 pills in the 2-24 hours before sex (closer to 24 hours is preferred)
1 pill 24 hours after the initial 2-pill dose
1 pill 48 hours after the initial 2-pill dose
Alternative Dosing
