HIV PREP Flashcards
3 Meds for PrEP
-Truvada (Em 200, Teno Diso 300)
-Descovy (Em 200, Teno Alaf 25)
-Apretude (Cabotegravir 600 mg/ml)
When to Use Each
-Truvada: all adults 35 kg + at risk for HIV
-Descovy: all adults 35 kg + at risk for HIV, except for ppl assigned female at birth receiving vaginal sex
-Cab: all adults 35 kg + at risk for HIV
U = U
Undetectable HIV-I RNA = Untransmittable Infection
RNA < 200 copies/ml
Same-day PrEP is NOT for:
-Ambivalent pts
-Blood can’t be drawn
-Signs of acute HIV
-Hx of renal disease (htn/dia)
-W/o insurance
-W/o confirmed means of contact
BARICH
Truvada: renal
-eCrCl >= 60
Descovy: renal
-eCrCl >= 30
Oral Prep AEs
-Nausea, HA, fatigue, abdominal dc (start up syndrome): resolves within first month
TDF/Truvada
-Weight loss, LDL reductions, decreased bone mineral
TAF/Descovy
-Weight gain, high TG
Rare: renal toxicity, Fanconi
TAF/Descovy DDIs
SJS, Rif drugs, Carb, pheny, phenobarbital, oxcarb
CROPPS
Stopping PrEP
-Protection will wane over 7-10 days
-Determine HIV status
NPEP (post-exp prophylaxis)
After an isolated sex/inj exposure
-Within 72 hours
-28 day course
If on PrEP:
-Fully adherent: no NPEP
-Poor adherence: NPEP maybe
Furnishing PEP/PrEP
Allows pharmacist to
-furnish 30 or 60 days of PREP once every 2 years
-furnish 28 days of PEP
- Neg HIV within 7 days
- No HIV sx
- No CI meds
- Counseling required
- Tell PCP
On Demand Oral PrEP for MSM
-2 pills within 24 hours before sex
-1 pill 24 hours after initial 2-pill dose
-1 pill 48 hours after initial 2-pill dose
-If sex occurs after completing, take 1 pill per day until 48 hours after sexual event
-Gap of <7, resume 1 pill daily
-Gap 7+, start again with 2 pills
Cabotegravir
-Patients with renal disease
-Difficulty adhering to oral
-Prefers injections
600 mg of Cab in butt once then one month later, then every 2 mo
30 mg oral Cab is optional for lead in
-Injection site rxns (otcs)
