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