In December 2021, the U.S. Centers for Disease Control and Prevention issued thoroughly revised and updated PrEP guidelines. The guidelines include important new information on the use of oral PrEP (TDF/FTC and TAF/FTC) and recommendations on the use of injectable cabotegravir (CAB) as PrEP.
Key updates include:
- Instructions to:
- Provide information about PrEP to all adults and adolescents who are sexually active
- Recommend PrEP for all adults and adolescents with sexual or injection risks for HIV exposure
- Prescribe PrEP if it is requested, even if the person denies HIV risk factors
- For Oral PrEP:
- Recommendations on use of TAF/FTC as a PrEP option for MSM and transgender women
- Information on intermittent/event-driven (2-1-1) TDF/FTC as a PrEP option for some MSM
- Recommendation to check HIV RNA at each monitoring interval (in addition to HIV Ag/Ab), to facilitate earlier and more reliable detection of new HIV infections
- Changes to frequency of CrCl and other lab monitoring
- Information on same-day prescribing
- Use of Telehealth for provision of PrEP
- Recommendation to prescribe a total oral PrEP supply of <=90 days (in order to test for HIV before further refills)
- For CAB:
- Extensive information on injectable CAB as a PrEP option for all adults and adolescents age 18 and older with sexual risks for HIV infection (see Long-acting Injectable PrEP Approved – Cabotegravir for more information).
References:
U.S. Centers for Disease Control and Prevention: U.S. Public Health Service: Preexposure Prophylaxis for the Prevention of HIV Infection in the United States—2021 Update: A Clinical Practice Guideline. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf. Published December 2021.
U.S. Centers for Disease Control and Prevention: U.S. Public Health Service: Preexposure Prophylaxis for the Prevention of HIV Infection in the United States—2021 Update: Clinical Providers’ Supplement. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-provider-supplement-2021.pdf. Published December 2021.
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About Susa Coffey, MD
Susa Coffey is medical editor of the NCRC. She is a Professor of Medicine at UCSF in the Division of HIV, Infectious Diseases and Global Medicine. Also, she is a longtime clinician and educator in HIV at San Francisco General Hospital clinic (“Ward 86”). She is also the Medical Editor of HIV InSite. Dr. Coffey is Co-Lead of the RAPID clinical program at Ward 86, San Francisco General Hospital and the Chair of the RAPID Committee of San Francisco's Getting to Zero campaign.