Updated guidelines from the Centers for Disease Control and Prevention (CDC) issued in May 2014 recommend Truvada PrEP for people at substantial risk for HIV infection.

The CDC recommends PrEP “as one prevention option” for sexually active men who have sex with men, heterosexual men and women, and injection drug users. PrEP is also “one of several options” to protect the HIV-negative partner in a mixed HIV status couple trying to conceive.

“Substantial risk” includes:

  •      having HIV-positive sexual partners or drug-injecting partners
  •      a high number of sex partners
  •      recent sexually transmitted infections (STIs)
  •      inconsistent or no condom use
  •      sex work
  •      sharing injection equipment

The only FDA-approved PrEP regimen is once-daily Truvada (300 mg tenofovir plus 200 mg emtricitabine), starting with no more than a 90-day supply (some providers start patients with a 30-day supply and check-in with them about adherence and risk factors before graduating to a 90-day supply). The CDC does not recommend any schedule besides continuous daily use, for example, taking Truvada only before sex or as a “morning-after” pill.

HIV testing should be done immediately before starting PrEP. People with symptoms of possible acute HIV infection (such as fever, sore throat, a rash, or swollen glands) should get a viral load (HIV RNA) test or wait to start PrEP.

Kidney function and hepatitis B status should also be checked before starting PrEP (the tenofovir in Truvada is also active against hepatitis B virus).

People on PrEP should have follow-up visits every three months that include HIV testing, assessment of side effects and STI symptoms, adherence counseling, and pregnancy testing if appropriate. STI and kidney function tests should be done every six months.