eCase - PrEP Fundamentals

Let’s review some key updates to the revised CDC PrEP guidelines released in 2021.

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CDC 2021 PrEP Guidelines: Key Updates

The CDC guidelines on PrEP were updated in 2021 to coincide with the FDA approval of cabotegravir (CAB) as the first extended-release injectable PrEP product.⁴ Among key updates is the recommendation that we broaden our message to make sure everyone who might benefit from PrEP is aware of its availability by discussing it with all sexually active patients and prescribing it to anybody who asks for it.

Recommendations on HIV testing also have been revised. HIV status now should be assessed at follow-up visits during and recently after PrEP with an HIV-1 RNA qualitative or quantitative assay for everyone receiving oral and injectable PrEP. The recommended frequency for testing is every 3 months with oral PrEP and every 2 months with long-acting (LA) injectable CAB. In the HPTN 083 study of LA injectable CAB vs daily oral PrEP in men who have sex with men (MSM) and transgender women (TGW), HIV detection with antigen or antibody testing was delayed compared with qualitative HIV-1 RNA testing in both groups.⁵

Revised recommendations on renal monitoring advise that individuals who are not at risk for renal disease—that is, people younger than 50 years of age with estimated creatinine clearance (CrCl) ≥90 mL/min—need only annual renal monitoring if receiving oral PrEP with either TDF or TAF in combination with FTC. People receiving oral PrEP who do not meet these criteria should receive renal monitoring every 6 months. People receiving CAB PrEP do not need renal monitoring.

Finally, annual monitoring of triglycerides and cholesterol is recommended for those receiving oral FTC/TAF PrEP in recognition of the elevated triglyceride levels and weight gain seen with use of FTC/TAF compared with FTC/TDF among men in the DISCOVER trial.⁶

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The Fundamentals of Selecting Individualized HIV PrEP Regimens

Activity

You are providing care for a 55-year-old cisgender man who has been in a monogamous sexual relationship with an HIV-negative individual for the past 2 years. According to 2021 CDC guidelines, should PrEP be discussed with this patient?

You are caring for a 27-year-old man who has been receiving oral emtricitabine (FTC)/tenofovir alafenamide (TAF) daily for PrEP for the past 2 years. When routinely monitoring him for HIV infection, should you do HIV-1 RNA testing?

CDC 2021 PrEP Guidelines: Key Updates

You are providing care for a 55-year-old cisgender man who has been in a monogamous sexual relationship with an HIV-negative individual for the past 2 years. According to 2021 CDC guidelines, should PrEP be discussed with this patient?

You are caring for a 27-year-old man who has been receiving oral emtricitabine (FTC)/tenofovir alafenamide (TAF) daily for PrEP for the past 2 years. When routinely monitoring him for HIV infection, should you do HIV-1 RNA testing?