PEP and PrEP

Question 1

what medication in Prep?

Answer 1

Truvada ie. Tenofovir disoproxil and emtricitabine

Question 2

What are the indications for PrEp use?

Answer 2

• MSM UPAI in last 6/12 and likely to continue
• ## partner of PLWHIV if VL >200 (or newly diagnosed)

Question 3

Can Tenofovir alone be used for PrEP?

Answer 3

NOT for MSM (due to lack of evidence) but can be for heterosexuals if Emtricitabine is contra-indicated

Question 4

How to take PrEP: for anal sex

Answer 4

Double dose 2-24 hours before, continue once daily, for 48 hours after last risk
nb. If <7 days since last dose can restart with single dose

Question 5

How to take PrEP: for vaginal sex

Answer 5

start 7 days before sex and continue for at least 7 days after last risk

Question 6

When missing PrEP when is efficacy effected?

Answer 6

If taking <4 in 7/7

Question 7

in PrEP, how should you respond to eGRF and how often to check?

Answer 7

> 90 at baseline: annual eGFR
60-90 at baseline OR age >40: 6 monthly eGFR
<60: risks vs benefit, involve renal

Question 8

When would someone on PrEP require PEP?

Answer 8

• if AI and <3 tablets in last 7 days

- in VI and >48 hours since last dose (or <6 tablets in last 7 days)

Question 9

risk of HIV transmission=

Answer 9

Risk that the source is +ve x risk of that exposure

Question 10

At what transmission risk is PEP recommended?

Answer 10

> 1 in 1000

Question 11

What is the baseline HIV drug resistance in the UK?

Answer 11

MSM 7.2%

Heterosexuals 6%

Question 12

What type of medication is Truvada?

Answer 12

NRTI

Question 13

What type of medication is Raltegravir?

Answer 13

Intergrase inhibitor

Question 14

What are PEP alternative drugs?

Answer 14

Combivir (instead of Truvada)

Kaletra or Dolutegravir (instead of Raltegravir)