PREP / PEP

Question 1

PrEP Meds Overview

Answer 1

The US Food and Drug Administration (FDA) has approved three medications for use as PrEP, which are listed below. Two consist of a combination of drugs in a single oral tablet taken daily. The third medication is a medicine given by injection every 2 months.

Question 2

Injectable v Oral PrEP

Answer 2

Injectible when kidney disease exists, or can’t tolerate oral meds

Question 3

PrEP Use Guidelines

Answer 3

Use CDC criteria but counsel all sexually active patients about it.

Question 4

HIV Status

Answer 4

Check before prescripting PrEP

Question 5

Testing before PrEP

Answer 5

Lipids, HIV, STI, HepB

Question 6

Monitor while on PrEP

Answer 6

Creatinine Clearance, HIV, STI, Lipids

Question 7

Time to PrEP Effectiveness (and wane)

Answer 7

7-10 days (21 for vaginal) for oral
Injectable unclear, but 1 month usually

Question 8

2-1-1 or Event Driven Dosing

Answer 8

Oral for MSM. Take 2 pills 24 hours prior to planed sex, 1 pill 24 hours after first two pills, then 1 pill 48 hours after first two pills. Off-label use.

Question 9

PEP Overview

Answer 9

PEP is the use of antiretroviral medication to prevent HIV infection in an HIV-negative person who has had a specific high-risk exposure to HIV. Must be done within 72 hours

Question 10

PEP Prescribing

Answer 10

All persons offered PEP should be prescribed a 28-day course of a 3-drug antiretroviral regimen. Since adherence is critical for PEP efficacy, it is preferable to select regimens that minimize side effects, number of doses per day and the number of pills per dose.

The preferred PEP regimen for otherwise healthy adults and adolescents is tenofovir disoproxil fumarate (TDF) (300 mg) + emtricitibine (FTC) 200 mg) once daily PLUS raltegravir (RAL) (400 mg) twice daily or dolutegravir (DTG) (50 mg) once daily).

Question 11

PEP Baseline Testing

Answer 11

Rapid HIV, Pregnancy, Liver enzymes, BUN/CR. STI, HepB, HepC. Start PEP before testing if time is an issue.