PrEP Provider Toolkit: Indications

PrEP Provider Toolkit

Patient Eligibility

Indications

The CDC published the latest national guideline for PrEP in December 2021. It includes several tables that detail all of the patient indications for PrEP use which can be found here.

The following table summarizes this information with minor modifications to improve simplicity and includes certain details that were omitted.

Indications for Pre-Exposure Prophylaxis
PrEP is indicated if ALL of the following applies: Is ≥12 years old Weighs ≥35kg (77 lbs) Has had a negative HIV test within the last week¹ And ONE of the following risk factors in the past 6 months
Risk Factors: High-risk sex² with a partner(s) of unknown HIV status Sex with an HIV+ partner Diagnosed and/or treated for a STI⁴ Share injection drug equipment with partner(s) of unknown HIV status⁵ Requested and/or utilized non-occupational post-exposure prophylaxis (nPEP) Requesting PrEP without disclosing further details
Indications for Specific Therapies: F/TDF (Truvada) - eCrCl ≥ 60ml/min⁶ F/TAF (Descovy) - MSM/TGWSM only, eCrCl ≥ 30ml/min CAB (Apretude) - no eCrCl cutoff
Footnotes Lab-based 4th-gen HIV Ab/Ag test OR a POC HIV Ag/Ab test (Abbott Determine). Oral fluid tests or HIV-Ab only POC tests are not recommended. Additional HIV-RNA testing is recommended if the patient has been on oral PrEP/PEP in the past 3 months or injectable PrEP in the past year. High risk sex: inconsistent condom use, anal sex, transactional sex, or sex+substance abuse with partner(s) of unknown HIV status. HIV+ partners with viral loads consistently <200 copies/mL for ≥6 consecutive months pose a negligible risk of sexually transmitting HIV. U=U: ₍₁₅₎ undetectable = untransmittable Eisinger RW, Dieffenbach CW, Fauci AS. HIV Viral Load and Transmissibility of HIV Infection: Undetectable Equals Untransmittable. JAMA. 2019;321:451-2. Chlamydia, gonorrhea, syphilis, genital herpes ₍₁₆₎, bacterial vaginosis ₍₁₇₎, trichomoniasis. ₍₁₈₎. Kissinger P, Adamski A. Trichomoniasis and HIV interactions: a review. Sex Transm Infect. 2013 Sep;89(6):426-33. doi: 10.1136/sextrans-2012-051005. Epub 2013 Apr 20. PMID: 23605851; PMCID: PMC3748151. Source: Centers for Disease Control and Prevention. (2022). Diagnoses of HIV infection in the United States and dependent areas, 2020. U.S. Department of Health and Human Services. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2020-updated-vol-33.pdf Todd J, Grosskurth H, Changalucha J, Obasi A, Mosha F, Balira R, Orroth K, Hugonnet S, Pujades M, Ross D, Gavyole A, Mabey D, Hayes R. Risk factors influencing HIV infection incidence in a rural African population: a nested case‐control study.. J Infect Dis 2006;193(3):458‐466. Wald A, Link K. Risk of Human Immunodeficiency Virus infection in herpes simplex virus type 2 ‐ seropositive persons: a meta‐analysis. The Journal of Infectious Diseases 2002;185:45‐52. Freeman EE, Weiss HA, Glynn JR, Cross PL, Whitworth JA, Hayes RJ. Herpes simplex virus 2 infection increases HIV acquisition in men and women: systematic review and meta‐analysis of longitudinal studies. AIDS 2006;20(1):73‐83. U=U has not been proven in HIV transmission that occurs through IV drug use eCrCl: estimated creatinine clearance. Calculated using the Cockcroft-Gault Equation
Table 1. Indications to utilize PrEP

Indications for Pre-Exposure Prophylaxis

PrEP is indicated if ALL of the following applies:

Is ≥12 years old
Weighs ≥35kg (77 lbs)
Has had a negative HIV test within the last week¹
And ONE of the following risk factors in the past 6 months

Risk Factors:

High-risk sex² with a partner(s) of unknown HIV status
Sex with an HIV+ partner
Diagnosed and/or treated for a STI⁴
Share injection drug equipment with partner(s) of unknown HIV status⁵
Requested and/or utilized non-occupational post-exposure prophylaxis (nPEP)
Requesting PrEP without disclosing further details

Indications for Specific Therapies:

F/TDF (Truvada) - eCrCl ≥ 60ml/min⁶
F/TAF (Descovy) - MSM/TGWSM only, eCrCl ≥ 30ml/min
CAB (Apretude) - no eCrCl cutoff

Footnotes

Lab-based 4th-gen HIV Ab/Ag test OR a POC HIV Ag/Ab test (Abbott Determine).
Oral fluid tests or HIV-Ab only POC tests are not recommended. Additional HIV-RNA testing is recommended if the patient has been on oral PrEP/PEP in the past 3 months or injectable PrEP in the past year.
High risk sex: inconsistent condom use, anal sex, transactional sex, or sex+substance abuse with partner(s) of unknown HIV status.
HIV+ partners with viral loads consistently <200 copies/mL for ≥6 consecutive months pose a negligible risk of sexually transmitting HIV. U=U: ₍₁₅₎ undetectable = untransmittable

Chlamydia, gonorrhea, syphilis, genital herpes ₍₁₆₎, bacterial vaginosis ₍₁₇₎, trichomoniasis. ₍₁₈₎.

Kissinger P, Adamski A. Trichomoniasis and HIV interactions: a review. Sex Transm Infect. 2013 Sep;89(6):426-33. doi: 10.1136/sextrans-2012-051005. Epub 2013 Apr 20. PMID: 23605851; PMCID: PMC3748151.

U=U has not been proven in HIV transmission that occurs through IV drug use
eCrCl: estimated creatinine clearance. Calculated using the Cockcroft-Gault Equation

Table 1. Indications to utilize PrEP