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Administration of pre-exposure prophylaxis against HIV infection

Authors
Kenneth H Mayer, MD
Douglas Krakower, MD
Section Editors
John G Bartlett, MD
Paul E Sax, MD
Deputy Editor
Jennifer Mitty, MD, MPH

INTRODUCTION

Up to two million new HIV infections occur yearly worldwide. As there is no effective vaccine to prevent HIV transmission, behavioral and biomedical HIV prevention strategies are needed to reduce HIV acquisition [1-3]. For HIV-uninfected patients, pre-exposure prophylaxis (PrEP) using antiretroviral medications is an evidence-based way to prevent new infections among those at greatest risk.

This topic will review how to administer PrEP to appropriate candidates. A discussion of how to assess patients for PrEP and other strategies to prevent HIV infection (eg, the use of antiretroviral therapy for HIV-infected patients, post-exposure prophylaxis for HIV-uninfected patients, and male circumcision) are discussed elsewhere. (See "Patient evaluation and selection for HIV pre-exposure prophylaxis" and "HIV infection: Risk factors and prevention strategies" and "Management of nonoccupational exposures to HIV and hepatitis B and C in adults" and "Management of healthcare personnel exposed to HIV".)

ASSESSING PATIENTS FOR PrEP

To determine who should receive pre-exposure prophylaxis (PrEP), clinicians should assess the potential benefits and risks of therapy (table 1). Among those who are adherent, PrEP using tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) can reduce the risk of HIV transmission by greater than 90 percent, although rare infections may still occur [4-6].

The initial evaluation of a patient who is interested in initiating PrEP is summarized below and described in detail elsewhere:

Clinicians should obtain a detailed sexual and drug use history to determine if the patient is at high risk of HIV acquisition, and therefore likely to benefit from PrEP. (See "Patient evaluation and selection for HIV pre-exposure prophylaxis", section on 'Assessing risk of HIV acquisition'.)

                                
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Literature review current through: Oct 2017. | This topic last updated: Oct 10, 2017.
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