In the latest MMWR, the CDC offers interim guidance to health-care providers based on the reported results of the iPrEx trial, which indicated that TDF plus FTC taken orally once a day as preexposure prophylaxis (PrEP) is safe and partially effective in reducing HIV acquisition among MSM when provided with regular monitoring of HIV status and ongoing risk-reduction and PrEP medication adherence counseling.
Official guidelines will be issued in a few months after hearing expert input, but until then, the CDC recommends PreP only for MSM.
To read the full report go here http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6003a1.htm?s_cid=mm6003a1_w
The guidelines are:
Before initiating PrEP
>> Document negative HIV antibody test(s) immediately before starting PrEP medication.
>>Test for acute HIV infection if patient has symptoms consistent with acute HIV infection.
>> Confirm that patient is at substantial, ongoing, high risk for acquiring HIV infection.
>>Confirm that calculated creatinine clearance is ≥60 mL per minute (via Cockcroft-Gault formula).
Other recommended actions
>>Screen for hepatitis B infection; vaccinate against hepatitis B if susceptible, or treat if active infection exists, regardless of decision about prescribing PrEP.
>>Screen and treat as needed for STIs.
Beginning PrEP medication regimen
>>Prescribe 1 tablet of Truvada* (TDF [300 mg] plus FTC [200 mg]) daily.
>>In general, prescribe no more than a 90-day supply, renewable only after HIV testing confirms that patient remains HIV-uninfected.
>> If active hepatitis B infection is diagnosed, consider using TDF/FTC for both treatment of active hepatitis B infection and HIV prevention.
>>Provide risk-reduction and PrEP medication adherence counseling and condoms.
Follow-up while PrEP medication is being taken
>Every 2--3 months, perform an HIV antibody test; document negative result.
>Evaluate and support PrEP medication adherence at each follow-up visit, more often if inconsistent adherence is identified.
>Every 2--3 months, assess risk behaviors and provide risk-reduction counseling and condoms. Assess STI symptoms and, if present, test and treat for STI as needed.
>Every 6 months, test for STI even if patient is asymptomatic, and treat as needed.
>3 months after initiation, then yearly while on PrEP medication, check blood urea nitrogen and serum creatinine.
On discontinuing PrEP (at patient request, for safety concerns, or if HIV infection is acquired)
>Perform HIV test(s) to confirm whether HIV infection has occurred.
>If HIV positive, order and document results of resistance testing and establish linkage to HIV care.
>If HIV negative, establish linkage to risk-reduction support services as indicated.
>If active hepatitis B is diagnosed at initiation of PrEP, consider appropriate medication for continued treatment of hepatitis B.