Injectable PrEP
Introduction and the Australian Context: On the 8th of August 2022, the Australian Therapeutic Goods Administration (TGA) approved the use of long-acting injections of cabotegravir (CAB-LA) as HIV pre-exposure prophylaxis (PrEP) for adults and adolescents with HIV acquisition risk (for those at least 12 years of age and weighing at least 35 kg). In September […]
Other PrEP dosing schedules
There is some online guidance currently available that recommends that MSM taking PrEP can use a dosing schedule where they take a single dose of PrEP on Tuesdays, Thursdays, Saturdays and Sundays, known as ‘the Ts and Ss’. While the motive for simplifying the PrEP dosing schedule is laudable the ASHM PrEP Guidelines Panel does not recommend the […]
Evaluation of the need for ongoing PrEP
Along with encouraging safer sex practices and safer injecting techniques, as needed, clinicians should support their patients to decide when to commence PrEP and when to discontinue its use. The duration of PrEP use will depend on whether the person’s risk of HIV continues over time. PrEP should only be prescribed to those patients who are able […]
Laboratory and clinical follow-up schedule at baseline and follow-up
The recommended schedule of testing and follow-up of people on PrEP is outlined in the Table 7.1 in Clinical follow-up and monitoring of patients on PrEP.
Indicated medication
The medications proven safe and effective, and currently approved by the TGA for PrEP in healthy adults at risk of acquiring HIV infection, are the fixed-dose combination of TD* and FTC in a single daily dose. Therefore, TD*/FTC or other generic versions of TD*/FTC are the recommended medications that should be prescribed for PrEP for […]
What not to use for PrEP
DO NOT use any HIV antiretroviral medications, either in place of, or in addition to TD* or FTC. Do not provide PrEP as expedited partner therapy (i.e. do not prescribe for a person who is not in your care).
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 […]