References
Australasian Sexual Health Alliance (ASHA). Australian STI management guidelines for use in primary care[internet]. Last updated December 2018. Available at: http://www.sti.guidelines.org.au/ (last accessed 30 August2019). Masciotra S, McDougal JS, Feldman J, Sprinkle P, Wesolowski L, Owen SM. Evaluation of an alternative HIVdiagnostic algorithm using specimens from seroconversion panels and persons with established HIV infections. JClin Virol 2011 […]
Optional assessments
Therapeutic drug monitoring Initial demonstration projects in Australia conducted therapeutic drug monitoring as part of research protocols to evaluate medication adherence and HIV seroconversions among study participants. Their results revealed a high correlation between self-reports of tablet taking and blood concentrations of TD* and FTC, and high adherence to PrEP (over 90%) 15, 16. However, in Australia there […]
Managing side-effects
Patients taking PrEP should be assessed for side-effects associated with TD*/FTC use, most importantly those suggesting possible acute renal injury. A review of symptoms experienced in the iPrEx (Iniciativa Profilaxis Pre-Exposición) study showed that potential PrEP-associated symptoms peaked at 1 month, when 39% of participants reported symptoms, compared with 22% at baseline. Gastrointestinal (GI) symptoms occurred in […]
Monitoring HBV Hepatitis B and HCV Hepatitis C virus infections
Hepatitis B virus monitoring For people who are hepatitis B virus (HBV) non-immune at baseline, clinicians should provide hepatitis B vaccination and confirm their immune response 1 month after the last vaccine dose. For people who state that they have been vaccinated for hepatitis B at baseline, clinicians should test for hepatitis B surface antibody; if their […]
Testing for STIs
As PrEP users are at increased risk for STIs 7 clinicians should screen for STIs (specifically gonorrhoea, chlamydia and infectious syphilis) every 3 months using the standard-of-care tests and procedures, and manage any detected STI as recommended by the Australian STI Management Guidelines 1. Partner notification should be undertaken using the most appropriate available resources. It is important […]
Monitoring of renal function
Renal function should be monitored at 3 months and 6 monthly thereafter, or more frequently in certain populations (see Assessment of renal function at baseline). The management of people with high and ongoing risk of HIV infection, but whose eGFR has declined below or around 60 mL/min/1.73 m2 since commencing TD*/FTC, is challenging. This situation […]
A recent high-risk exposure (within 72 hours)
A course of non-occupational post exposure prophylaxis (nPEP) may be required if a patient is on daily PrEP, or on-demand† PrEP and had a recent high-risk exposure (within 72 hours) but only if they did not take PrEP during those days. This nPEP may need to consist of a three-drug regimen, depending on the nature of the exposure. See […]
Indeterminate HIV test results in the first 3 months on PrEP
There is a potential for PrEP to delay or attenuate seroconversion in people who may have been exposed to HIV just before starting PrEP, or who acquire HIV infection while taking PrEP (e.g. due to poor adherence or transmitted drug resistant virus) 4-6. There is not a broad international agreement on how to manage these patients. Patients who […]
A positive HIV test result
Any positive HIV test result should be managed urgently by appropriate counselling and referral to an HIV prescriber. Assistance can be sought via telephone from a local sexual health clinic. It is very important for the clinician to recognise that HIV acquisition in a person who is using PrEP is a highly significant event and that the emphasis […]
Testing for HIV
HIV testing should be repeated every 3 months using a fourth generation HIV antibody and antigen test via a venous blood draw. Rapid point-of-care tests, including the recently approved home testing HIV diagnostic kit, the Atomo HIV Self Test, should not be used for monitoring patients receiving PrEP. A patient’s ongoing HIV risk and adherence to PrEP […]