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PrEP Guidelines and Resources for Clinicians

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Excerpt:

CDC has released a 2017 update to the clinical practice guidelines for PrEP. The new guidelines

  • Provide clear criteria for determining a person’s HIV risk and indications for PrEP use.
  • Require that patients receive HIV testing to confirm negative status before starting PrEP.
  • Recommend regular monitoring of HIV infection status, side effects, adherence, and sexual or injection risk behaviors.
  • Underscore importance of counseling about adherence and HIV risk reduction, including encouraging condom use for additional protection.
  • The update to the providers’ supplement offers clinicians additional materials and tools for use when prescribing PrEP.

The guidelines recommend that PrEP be offered to people who are HIV-negative and at substantial risk for HIV.

For sexual transmission, this includes anyone who 1) is not in a mutually monogamous* relationship with a partner who recently tested HIV-negative, and 2) is a

  • gay or bisexual man who has had anal sex without a condom or been diagnosed with an STD in the past 6 months; or
  • heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (e.g., people who inject drugs or have bisexual male partners).

For people in HIV-discordant couples where one sexual partner is HIV-positive and the other is HIV-negative. PrEP can be especially useful when the HIV-positive partner is not taking antiretroviral medications or does not have an undetectable viral load. Health care providers should also discuss the use of PrEP with HIV discordant heterosexual couples during conception and pregnancy as one of several options to protect the partner who is HIV-negative.

For people who inject drugs, this includes those who have injected illicit drugs in the past 6 months and who have shared injection equipment or been in drug treatment for injection drug use in the past 6 months.

Patients on PrEP should return to their health care provider every 3 months for a repeat HIV test and other follow-up. At this time, the provider can write a prescription refill, offer counseling about medication adherence and risk reduction, test for STDs if necessary, and assess side effects.

PrEP is only for people who are at ongoing substantial risk of HIV infection. For people who need to prevent HIV after a single high-risk event of potential HIV exposure—such as unprotected sex, needle-sharing injection drug use, or sexual assault—there is another option called postexposure prophylaxis, or PEP.  PEP must begin within 72 hours of exposure. See our PEP guidelines.

* Mutually monogamous means that you and your partner only have sex with each other and do not have sex outside the relationship.

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