595 Pre-exposure Prophylaxis (PrEP)
Post-exposure Prophylaxis (PEP) Exam
2023/2024
Objectives - ANSWER-- Differentiate between HIV pre-exposure prophylaxis (PrEP) and HIV post-
exposure prophylaxis (PEP)
- Define and identify indications for PrEP
- Summarize the evidence supporting the use of PrEP in different patient populations
- Explain the risks and benefits of PrEP
- Identify key counseling points for patients initiating PrEP
Background for PEP and PrEP - ANSWER-- The annual number of new HIV diagnoses remained stable
between 2012 and 2016.
Most and Least Affected Subpopulations in 2018 - ANSWER-Most affected
- MTM Sexual Contact Black Americans
Least affected
- Heterosexual contact, White women
Types of HIV Post-exposure Prophylaxis (PEP) - ANSWER-- Nonoccupational Post-exposure Prophylaxis
(nPEP)
- Occupational Post-exposure Prophylaxis (oPEP)
nPEP Risk Factors - ANSWER-- nonoccupational exposure to blood, genital secretions
- Sexual contact
- IVDU exposure
oPEP Risk Factors - ANSWER-- Needlestick or cut with a sharp object
, - Health care workers exposure
HIV PEP Treatment Regimens - ANSWER-- Must be initiated <72 hours of exposure to be effective
- Truvada + Raltegravir (RAL) 400mg BID
- Truvada + Dolutegravir (DTG) 50mg qd
- Take Either for 28 days
- Guidelines say to use Dolutegravir with caution in women with childbearing potential.
PEP HIV Monitoring - ANSWER-- HIV Ag/Ab test (4th generation test)
- HIV testing at baseline
- Follow up HIV test at 4-6 weeks, 3 months, and 6 months after exposure
Pre-exposure prophylaxis (PrEP) drug regimen - ANSWER-- Fixed-dose combination of emtricitabine (FTC)
200mg and tenofovir disoproxil fumarate (TDF) 300mg (Truvada®) 1 tablet by mouth daily
- Cannot be used in patients with CrCl ≤ 60mL/min
What is the newly approved 2nd PrEP drug regimen - ANSWER-- Fixed-dose combination of emtricitabine
(FTC) 200mg and tenofovir alafenamide(TAF) 25mg (Descovy®) 1 tablet by mouth daily
- To reduce the risk of HIV-1 infection from sex, EXCLUDING those who have receptive vaginal sex
- Cannot be used in patients with CrCl ≤ 30mL/min
Why emtricitabine/tenofovir for HIV PrEP? - ANSWER-- Long half lives allows for once daily dosing
- Good intracellular drug concentrations
- Few drug-drug interactions
- Generally well tolerated
- High barrier to resistance
Significant Drug-Drug Interactions with PrEP Drugs? - ANSWER-Ledipasvir/Sofosbuvir (HepC treatment)
- Serum conentration of TDF may be increased
Post-exposure Prophylaxis (PEP) Exam
2023/2024
Objectives - ANSWER-- Differentiate between HIV pre-exposure prophylaxis (PrEP) and HIV post-
exposure prophylaxis (PEP)
- Define and identify indications for PrEP
- Summarize the evidence supporting the use of PrEP in different patient populations
- Explain the risks and benefits of PrEP
- Identify key counseling points for patients initiating PrEP
Background for PEP and PrEP - ANSWER-- The annual number of new HIV diagnoses remained stable
between 2012 and 2016.
Most and Least Affected Subpopulations in 2018 - ANSWER-Most affected
- MTM Sexual Contact Black Americans
Least affected
- Heterosexual contact, White women
Types of HIV Post-exposure Prophylaxis (PEP) - ANSWER-- Nonoccupational Post-exposure Prophylaxis
(nPEP)
- Occupational Post-exposure Prophylaxis (oPEP)
nPEP Risk Factors - ANSWER-- nonoccupational exposure to blood, genital secretions
- Sexual contact
- IVDU exposure
oPEP Risk Factors - ANSWER-- Needlestick or cut with a sharp object
, - Health care workers exposure
HIV PEP Treatment Regimens - ANSWER-- Must be initiated <72 hours of exposure to be effective
- Truvada + Raltegravir (RAL) 400mg BID
- Truvada + Dolutegravir (DTG) 50mg qd
- Take Either for 28 days
- Guidelines say to use Dolutegravir with caution in women with childbearing potential.
PEP HIV Monitoring - ANSWER-- HIV Ag/Ab test (4th generation test)
- HIV testing at baseline
- Follow up HIV test at 4-6 weeks, 3 months, and 6 months after exposure
Pre-exposure prophylaxis (PrEP) drug regimen - ANSWER-- Fixed-dose combination of emtricitabine (FTC)
200mg and tenofovir disoproxil fumarate (TDF) 300mg (Truvada®) 1 tablet by mouth daily
- Cannot be used in patients with CrCl ≤ 60mL/min
What is the newly approved 2nd PrEP drug regimen - ANSWER-- Fixed-dose combination of emtricitabine
(FTC) 200mg and tenofovir alafenamide(TAF) 25mg (Descovy®) 1 tablet by mouth daily
- To reduce the risk of HIV-1 infection from sex, EXCLUDING those who have receptive vaginal sex
- Cannot be used in patients with CrCl ≤ 30mL/min
Why emtricitabine/tenofovir for HIV PrEP? - ANSWER-- Long half lives allows for once daily dosing
- Good intracellular drug concentrations
- Few drug-drug interactions
- Generally well tolerated
- High barrier to resistance
Significant Drug-Drug Interactions with PrEP Drugs? - ANSWER-Ledipasvir/Sofosbuvir (HepC treatment)
- Serum conentration of TDF may be increased
