Texas Health and Human Services / Texas Health Steps

What is PrEP?

open bottle of prescription PrEP pills

PrEP is a once-daily oral medication for individuals who test negative for HIV and are at high risk for HIV disease. PrEP is not recommended for individuals living with HIV because it cannot fully prevent HIV replication and the virus strains they have can develop resistance to the full antiretroviral treatment for HIV.

Individuals at risk for HIV can take PrEP to prevent acquiring the virus from sex or injection of substances. If taken as prescribed, PrEP is highly effective in preventing HIV disease (HHS, 2021):

  • 99 percent reduction in risk of acquiring HIV from sex
  • 74 percent reduction in risk of acquiring HIV from injecting substances

PrEP is a combination of two antiretroviral medications in one daily tablet. The U.S. Food and Drug Administration (FDA) has approved two medication regimens for PrEP:

  1. A combination of emtricitabine (FTC) and tenofovir disoproxil fumarate (TDF), known as F/TDF
  2. A combination of FTC and tenofovir alafenamide (TAF), known as F/TAF

The FDA in 2012 approved use of PrEP by adults to prevent HIV. In 2018, it approved the use of PrEP by adolescents if their weight is 77 pounds or more.

In late 2021, the CDC recommended that health-care providers inform all sexually active adolescents and adults about PrEP. The use of PrEP for adolescents at high risk for HIV is encouraged by the American Academy of Pediatrics (AAP), the CDC, the Texas Health and Human Services Commission (HHSC), the Texas Department of State Health Services (DSHS) and other health groups.

PrEP is available at no cost to adolescents enrolled in Texas Health Steps. Prior authorization is not required. The federal government’s Ready, Set, PrEP program also makes PrEP available at no cost to eligible individuals who do not have health insurance for prescription medications.

Injectable PrEP

In late 2021, the FDA approved an injectable PrEP (cabotegravir extended-release injectable suspension) for adults and adolescents weighing 77 pounds or more. The injectable PrEP involves two initiation injections administered one month apart, and one injection every two months thereafter.

However, the injectable medication has not been tested in adolescents 17 years and younger. Studies are underway “but until safety is determined for this population, and reviewed by FDA, (the injectable PrEP) is not recommended for adolescents,” according to the CDC’s 2021 clinical practice guidelines for PrEP.

Know the Difference: PrEP versus PEP

PrEP should not be confused with PEP (post-exposure prophylaxis).

PEP is a 28-day regimen of HIV medications taken within 72 hours (3 days) after a possible exposure to HIV to prevent HIV. It is for individuals who:

  • May have been exposed to HIV during sex
  • Shared needles or other equipment to inject substances
  • Were sexually assaulted
  • May have been exposed to HIV at work

PEP should be used only in emergencies and not as a substitute for other HIV prevention methods. PEP is not recommended for individuals with frequent exposure to HIV. The CDC guidelines for PEP include recommendations for adolescents and children.

CDC guidelines for both PrEP and PEP are accessible from the Appendix of Resources at the end of this course.

Source: National Institutes of Health, 2021







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