PrEP dosing schedule
A daily PrEP regimen involves the person taking a single daily tablet at approximately the same time each day see figure 6.1. Taking the tablet some hours earlier or later than usual will not adversely influence the levels of the drug. If the person forgets to take a tablet for one day, there is no need to […]
PrEP medication side effects
Patients taking PrEP should be informed of TD*/FTC side-effects experienced by participants in PrEP trials. These include headache, nausea, flatulence and the potential for renal injury. Hepatotoxicity can occur but it is very uncommon. In these trials, side-effects were uncommon and usually resolved within the first month of taking PrEP (known as ‘start-up syndrome’). Clinicians should discuss the […]
PrEP medication drug interactions
In addition to the safety data obtained in PrEP clinical trials, data on drug-drug interactions and longer-term toxicities have been obtained by studying the component drugs individually for their use in treatment of people with HIV infection. Studies have also been performed in small numbers of healthy adults without HIV infection. No significant effect was seen, and no […]
Time to achieving and maintaining protection
The pharmacokinetics of TD* and FTC vary by tissue 24. Data from exploratory pharmacokinetic studies conducted with men and women without HIV infection suggest that maximum intracellular concentrations of tenofovir diphosphate are reached in blood after approximately 20 days of daily oral dosing 25, 26. Current evidence suggests that for both rectal and vaginal exposure, high protection is […]
PrEP and travel
PrEP and travel PrEP can play an important role in preventing HIV infection in people travelling outside of Australia, along with other measures to reduce HIV and STIs 30. If a patient wants to take daily PrEP while on an overseas trip, they can commence two tablets on the day of departure and cease PrEP […]
PEP use and PrEP
If a person is not taking PrEP but presents within 72 hours of a potential HIV exposure, they should be assessed for non-occupational post-exposure prophylaxis (nPEP) as a matter of urgency and should be offered nPEP immediately according to current nPEP guidelines if appropriate if HIV acquisition risk is likely to continue into the future, PrEP should be […]
Discontinuing daily PrEP in cis men
Clinicians should regularly advise people using PrEP about how to discontinue PrEP. The need for PrEP may end when a partner with HIV achieves sustained HIV viral suppression after at least 6 months of antiretroviral therapy, when a patient enters a mutually monogamous relationship with a seroconcordant partner, or when other social circumstances change. Discontinuing […]
Recommencing PrEP
Clinicians should advise any patient who has discontinued PrEP on how to safely recommence PrEP. Clinicians should advise that if and when a patient decides to recommence PrEP that they must first have repeat HIV testing in case they have acquired HIV infection during the time that they were not taking PrEP. All other baseline clinical and laboratory […]
References
Grant RM, Lama JR, Anderson PL, et al; iPrEx Study Team. Preexposure chemoprophylaxis for HIV preventionin men who have sex with men. N Engl J Med 2010;363:2587-99. McCormack S, Dunn DT, Desai M, et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised […]