Prophylaxis-HIV AIDS

(NEJM 2015;373:2237; Lancet 2016;387:53; J Infect Dis 2018;218:16; CDC 2021)

• Pre-exposure (PrEP): TDF/FTC daily, ↓ transmission >90% if adherent. Consider for serodiscordant partners, condomless sex in high-risk groups, STI w/in 6 mo, IVDU w/ equipment sharing. Rule out HIV prior to initiation, ✓ renal fxn, STIs, & HIV q3 mo.
• Post-exposure (PEP): start ASAP (within 72 hr) after high-risk exposure from HIV ⊕ source (case-by-case decision if HIV status ?). Test baseline HIV, STIs, HBV, HCV. Rx: 2 NRTIs (usually TDF/FTC) + RAL or DTG × 4 wks. Consider initiating PrEP afterwards.