Who Should Take PrEP and For How Long?

PrEP is for individuals who do not have HIV, have a high chance of getting HIV, desire protection from HIV and can commit to taking a daily pill. Candidates for PrEP include individuals who:

• Have a sexual partner or substance injection partner living with HIV
• Live in an area with a high rate of HIV
• Inject substances or share needles or other equipment related to substance use
• Have a sexual network with a high prevalence of HIV infection
• Have multiple sexual partners
• Have had a sexually transmitted infection such as chlamydia, gonorrhea or syphilis in the past 6 months
• Use PEP repeatedly
• Have sex without using condoms or with inconsistent use of condoms
• Trade sex for money, substances or housing
• Have sex while intoxicated or under the influence of other substances
• Have sex with individuals whose health status is unknown

Sources: AAP, 2022; DSHS and CDC, 2021

PrEP should be considered part of a comprehensive prevention plan that includes a discussion about adherence to PrEP, condom use, other sexually transmitted infections (STIs), and other risk reduction methods.

(CDC, 2021)

Before beginning PrEP, individuals must:

• Take an HIV test to ensure they are HIV negative
• Take a test to determine hepatitis B status
  • Hepatitis B virus (HBV) infection is not a contraindication to PrEP use. However, individuals with HBV who stop taking PrEP must have their liver function closely monitored for reactivation of HBV replication that may cause liver damage.
• Obtain a baseline evaluation and monitoring of renal function

In addition, individuals taking PrEP must see their health-care provider every 3 months for:

• Routine follow-up visits
• HIV testing
• PrEP prescription refills

PrEP does not become highly effective immediately. PrEP reaches maximum protection from HIV at different durations for different types of HIV exposures (CDC, 2021).

• At 7 days of daily use: PrEP offers maximum protection for receptive anal sex (“bottoming”)
• At 21 days of daily use: PrEP offers maximum protection for receptive vaginal sex and injection of substances
• No data are available for insertive anal sex (“topping”) or insertive vaginal sex

PrEP can be taken as long as an individual is vulnerable to HIV. “PrEP is safe. No significant health effects have been seen in people who are HIV-negative and have taken PrEP for up to 5 years” (HHS, 2022).

If an individual’s risk of getting HIV becomes low because of life changes, PrEP can be stopped. Likewise, individuals who cannot adhere to the once-daily regimen or who experience side effects such as diarrhea, nausea, headache, fatigue or stomach pain can stop taking the medication. Side effects usually go away over time (CDC, 2021).