HIV PrEP and PEP

Maximal intracellular levels of TDF/FTC are at what times

Rectal tissue – 7 days

Vaginal tissue – 20 days

Effectiveness of PrEP

Can reduce risk of HIV through sexual activity by up to 99% (and over 70% in people who inject drugs)

PrEP Regimen for all HIV-negative individuals suitable for PrEP

TDF 300 mg (Tenofovir disoproxil fumarate) + FTC 200 mg (Emtricitabine) – 1 tablet daily

(Strong recommendation, high-certainty evidence)

PrEP Regimen for HIV-negative cisgender men and transgender women in whom risk of HIV acquisition is related to sex with cisgender men

TDF 300 mg (Tenofovir disoproxil fumarate) + FTC 200 mg (Emtricitabine) – on demand dosing (Strong recommendation, moderate certainty evidence)

TAF 25 mg/FTC 300 mg – 1 tablet daily (Weak recommendation, highcertainty evidence)

CAB-LA 600 mg – 2 injections one month apart, followed by q 2 months (Strong recommendation, high-certainty evidence)

Alberta PrEP eligibility guidelines for MSM, Trans Women and Gender Diverse People

Condomless anal sex within last 6 months and any of:

• Infectious syphilis or bacterial STI in past 12 months

• nPEP (non-occupational HIV post-exposure prophylaxis) more than once

• Ongoing sexual relationship with HIV+ partner with substantial risk of transmissable HIV (e.g. VL detectable or HIV status unknown but from higher risk population – MSM or PWID)

• HIRI-MSM risk score ≥ 11

Alberta PrEP eligibility guidelines for heterosexual people

For HIV negative partner in an ongoing relationship with:

• HIV positive partner involving condomless vaginal/anal sex where the HIV positive partner has substantial risk of transmissible HIV (e.g. VL> 40 copies/mL)

OR

• HIV status unknown but from high prevalence population (e.g. MSM, PWID, countries with high HIV prevalence)

Alberta PrEP eligibility guidelines for PWID

sharing of injection drug use paraphernalia (e.g., needles, syringes, etc) with a person with a non-negligible risk of HIV infection

Rx Info for PrEP

Initial prescription x 30 days (no automatic refills)

No signs/symptoms of acute HIV in previous month, HIV negative test

AEs: Common – headache, abdominal pain, flatulence, Other – decreased renal function, decreased BMD

Refill prescription for no more than 90 days

Screen to see if still eligible for PrEP (follow-up HIV & STI testing every 3 months)

PEP Urgency

Combination antiretroviral therapy (cART, 3-drug regimens used to prevent acquisition of HIV infection)

cART should be given ASAP, within 72 hours

PEP Regimens

TDF/emtricitabine 1 tablet daily plus dolutegravir 50 mg daily

OR

TAF/emtricitabine/bictegravir 1 tablet daily

either regimen for 28 days