…but how do I provide PrEP?

Labs to order:

HIV Ag/Ab to confirm patient is HIV-1 negative
HIV viral load
Renal function
Use of rapid HIV testing: PrEP can be started same day based off rapid HIV testing, but you need to also get a standard test and be able to contact the patient with results of that.
Consider HBV - However this test should not prevent starting PrEP.
Lipid profile every 12 months for DESCOVY

Is the Patient Clinically Eligible?

Documented negative HIV Ag/Ab test result within 1 week before initially prescribing PrEP
No signs/symptoms of acute HIV infection
Estimated creatine clearance > 30ml/min (Descovy) OR > 60ml/min (Truvada)
- If renal impaired see below for additional dosing information

Oral FDA Approved Forms of PrEP:

Descovy - Dose 200mg/25mg taken daily
- Most common side effects: Diarrhea
Truvada - Dose 200mg/300mg taken daily (Note a generic form is available)
- Most common side effects: Headache, abdominal pain and weight loss

Injectable FDA Approved Forms of PrEP:

Apretude ® (cabotegravier or CAB) - Dose 600mg administered every 2 months
Yeztugo ® (lenacapavir or LEN) - Dose 463.5 mg/1.5 mL every 6 months
- Note: The first visit involves taking two pills with the first set of injections followed by two more pills the following day.
Most common side effect: Injection site pain
This form of PrEP may be a good option for people who:
- Have problems taking oral PrEP as prescribed.
- Prefer getting a shot every few months instead of taking oral PrEP.
- Have serious kidney disease that prevents use of oral PrEP medications.

Oral Dosing Considerations for Those with Renal Impairment:

CrCl <30 mL/min: Use is not recommended.
FTC:
CrCl 30 to 49 mL/min: 200 mg every 48 hours.
CrCl 15 to 29 mL/min: 200 mg every 72 hours.
CrCl <15 mL/min: 200 mg every 96 hours.
TAF:
CrCl <15 mL/min, without Hemodialysis: Use is not recommended.
CrCl <15 mL/min, with Hemodialysis: No renal dose adjustment is needed.
CrCl <30 mL/min: Use is not recommended.
CrCl 30 to 49 mL/min: FTC 200 mg/TDF 300 mg every 48 hours.

FTC:
CrCl 30 to 49 mL/min: 200 mg every 48 hours.
CrCl 15 to 29 mL/min: 200 mg every 72 hours.
CrCl <15 mL/min: 200 mg every 96 hours.
TDF:
CrCl 30 to 49 mL/min: 300 mg every 48 hours.
CrCl 10 to 29 mL/min: 300 mg every 72 to 96 hours.
CrCl <10 mL/min, without HD:No data available.
CrCl <10 mL/min, with HD: 300 mg every 7 days.