HIV PrEP: A Doctor's Guide to Prevention

Pre-exposure prophylaxis (PrEP) has transformed HIV prevention strategies by providing a highly effective tool for individuals at high risk of acquiring HIV. As a doctor, it is essential to understand the key aspects of PrEP to educate and guide patients appropriately. In this blog post, we will provide a comprehensive guide to HIV PrEP, including its benefits, indications, prescribing considerations, and monitoring.

Understanding HIV Pre-exposure Prophylaxis (PrEP)

1. Definition: PrEP refers to the use of antiretroviral medications by individuals who are HIV-negative but at high risk of acquiring the virus. When taken consistently, PrEP can greatly reduce the risk of HIV transmission.
2. Medication: The most common medication for PrEP is a combination of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC), marketed as Truvada. Another option is a combination of tenofovir alafenamide (TAF) and emtricitabine (FTC), marketed as Descovy.

Indications and Considerations

1. High-Risk Populations: PrEP is recommended for individuals at high risk of HIV, including:
   • Men who have sex with men (MSM)
   • Individuals in serodiscordant relationships (where one partner is HIV-positive)
   • Injection drug users
   • Commercial sex workers
2. Risk Assessment: A thorough assessment of the patient’s risk behaviors, sexual practices, and injection drug use is crucial to determine their eligibility and need for PrEP.

Prescribing and Monitoring

1. Baseline Evaluation: Before initiating PrEP, a comprehensive evaluation should be conducted, including:
   • HIV testing to confirm negative status
   • Baseline renal function and hepatitis B screening
   • STI testing
2. Adherence Counseling: Ensuring proper understanding of the importance of daily adherence to PrEP is essential. Adequate counseling should be provided to address patient concerns and promote medication adherence.
3. Prescription Considerations: PrEP can be prescribed by physicians, nurse practitioners, or other healthcare providers who are knowledgeable about PrEP and have proper training. Prescription frequency depends on the patient’s level of risk and preferences.
4. Monitoring: Regular follow-up visits are necessary to monitor the patient’s HIV status, ensure medication adherence, and assess for potential side effects. Key monitoring aspects include:
   • Quarterly HIV testing
   • Renal function monitoring
   • STI screening every three to six months
   • Counseling on safe sex practices and harm reduction strategies

Benefits and Efficacy

1. High Effectiveness: Consistent daily use of PrEP has been shown to reduce the risk of HIV transmission by over 90%. It is even more effective when combined with condom use and other risk reduction strategies.
2. Prevention of Other STIs: PrEP offers additional benefits by providing protection against certain sexually transmitted infections (STIs) like gonorrhea and chlamydia, as regular testing and treatment are part of the monitoring process.
3. Empowering Patients: PrEP empowers individuals at high risk to take control of their sexual health and reduces anxiety associated with HIV risk.

Conclusion

HIV PrEP has revolutionized HIV prevention strategies, providing a highly effective tool to reduce the risk of HIV transmission. As a doctor, understanding the benefits, indications, prescribing considerations, and monitoring of PrEP is crucial in guiding patients effectively. Through proper education, counseling, and monitoring, we can empower individuals at high risk of HIV infection to make informed decisions and prioritize their sexual health.