Nguyen (2026); HIV Prevention

Which body fluids are considered infectious/potentially infectious for HIV?

Which are NOT?

INFECTIOUS:

Blood

Semen

Vaginal/cervicovaginal secretions

Rectal secretions

Breast milk

Any visibly bloody body fluid

NOT INFECTIOUS:

Tears

Sweat

Urine

Nasal secretions

Saliva (unless visibly bloody)

Feces

Name (3) populations at substantial risk for acquiring HIV and therefore are candidates for HIV PrEP

* MSM (men who have sex with men)

* IVDU (Injection drug users, age > 18yo)

* heterosexually active adults (male, female, and transgender)

What are the currently available FDA-approved HIV PrEP options?

(Drug, Formulation, Route, Frequency)

(Hint: (2) PO, (2) Injectables)

Daily PO options:

Truvada (Emtricitabine/TDF)

Descovy (Emtricitabine/TAF)

Long-acting injectable options:

Apretude (Cabotegravir): First 2 injections: 4 weeks apart; then Q8 weeks

Yeztugo (Lenacapavir): Q6 months SQ injection

Which HIV PrEP regimen is approved for MSM & Transgender women (who have sex with men)?

Can this medication be used in cis-gender women or Injection Drug Users?

Descovy (Emtricitabine/TAF)

No, not FDA-approved in cis-gender women or Injection Drug Users

What is an appropriate oral alternative option for patients not approved to use Descovy for HIV PrEP?

Persons with HIV using this medication option may be at higher risk of which side effects as compared to those on Descovy?

Truvada (Emtricitabine/TDF)

Nephrotoxicity and decreased BMD from the TDF

Note: TAF may have more weight gain and increases in lipids compared to TDF

What are the brand and generic names for the product available as an IM injection used for HIV PrEP?

Do patients need to take a PO loading dose prior to starting the IM injection?

Apretude (Cabotegravir)

No, PO cabotegravir (Brand: Vocabria) is not required prior to initiation of IM cabotegravir. The PO cabotegravir is optional and can be used to determine patient's tolerability to the medication before they receive the long-acting injectable.

What populations are approved for Cabotegravir (Apretude) for HIV PrEP?

(Hint: (1) patient characteristic (4) different demographics)

* Characteristic: Adults/adolescents weighing > 35kg

* Demographics:

- MSM

- Transgender women

- Cis-gender women

- IVDU

What is the brand name for Lenacapavir product that is FDA-approved for HIV PrEP? How is it administered and how frequently?

What at-risk population(s) is this PrEP option approved for?

Yeztugo; Administered: SQ injection; Dosing frequency: Q6 months

All at-risk populations: MSM, transgender women, cis-gender women, IVDU

What is PEP and when should it be started?

PEP = Post-Exposure Prophylaxis: taking antiretrovirals AFTER exposure to potentially infectious body fluid to reduce risk of HIV infection.

PEP appears effective if started within 72 hours of exposure (ideally); the sooner, the better.

For each of the 5 scenarios, classify them as Occupational vs. Non-occupational:

1. Emergency department nurse sustains needlestick from HIV+ patient

2. Medical student gets blood splash to eye during surgery

3. Person who shares needles with HIV+ partner while injecting drugs

4. Phlebotomist sustains needlestick at home from family member's insulin syringe

5. Unprotected receptive anal intercourse with HIV+ partner

1. Emergency department nurse sustains needlestick from HIV+ patient (Occupational)

2. Medical student gets blood splash to eye during surgery (Occupational)

3. Person who shares needles with HIV+ partner while injecting drugs (Non-occupational)

4. Phlebotomist sustains needlestick at home from family member's insulin syringe (Non-occupational)

5. Unprotected receptive anal intercourse with HIV+ partner (Non-occupational)

What are the preferred and alternative oPEP/nPEP regimens?

(include dose, route, frequency); What is the duration of treatment?

oPEP = occupational PEP

nPEP = non-occupational

PEP; PEP regimens should contain 3 drugs:; 1 INSTI + 2 NRTIs

Preferred:

Bictegravir/Emtricitabine/TAF (Biktarvy); 1 tab PO daily

Alternative: Dolutegravir + 2 NRTI; () 2 NRTIs =

* Emtricitabine/TAF (Descovy)

* Emtricitabine/TDF (Truvada)

* Lamivudine/TDF (Cimduo)

Dolutegravir 1 tablet (=50mg) PO daily

Descovy, Truvada, Cimduo: 1 tablet PO daily

Treatment Duration: 28 days

What (3) criteria must ALL be met for nPEP to be recommended after a non-occupational HIV exposure?

All three must be present:

1. Substantial risk exposure, meaning infectious fluid via mucous membrane, non-intact skin, or percutaneous route

2. Source is known HIV-positive with detectable viremia or unknown viral suppression status

3. Exposure occurred less than 72 hours ago

Under CA SB-159 and SB-339, how many days of PrEP can a pharmacist furnish in a 2-year period?

Pharmacist can furnish up to 60-day supply per SB-159; expanded to 90-day supply per SB-339 (no more than once every 2 years without a prescription).

Under CA SB-159, how many days of PEP can a pharmacist furnish?

28-day PEP course