ID Board Review/Human Immunodeficiency Virus (HIV) Infection/HIV Prevention

Pre-Exposure Prophylaxis (PrEP)

 * PrEP = Tenofovir + Emtricitabine
 * Can reduce risk of HIV acquisition by >90%, and is offered to patients at risk for new HIV Infection

Indications for PrEP

 * Sexual Behaviors:
 * Patients with HIV-positive partner with detectable viral load
 * Patients that are MSM
 * Patients from high prevalence areas (e.g. sub-Saharan Africa) have have had:
 * Recent bacterial STI(s)
 * Sex in exchange for money
 * Inconsistent condom use
 * High number of partners
 * Injection Drug Use:
 * HIV-positive injecting partner
 * Sharing of injecting equipment

Contraindications to PrEP

 * Active HIV infection
 * 2-drug antiretroviral therapy would incompletely treat active HIV, and cause drug resistance

PrEP Requirements

 * Patients must have negative fourth-generation HIV testing and NO manifestations of acute HIV
 * As well as normal renal function, and documented Hep B infection/vaccination
 * Patients with chronic HBV infection can sometimes undergo combined HBV and PrEP Treatment

PrEP Follow Up

 * q 3 mo HIV testing, as well as
 * Risk-reduction counseling
 * Medication adherence/side-effect assessment
 * Regular Cr levels and screen for bacterial STIs