HIV Pre-Exposure Prophylaxis Algorithm: Men Who Have Sex With Men

• Screen for hepatitis B virus (HBV) infection

— Vaccinate if susceptible

— Treat if active infection exists, regardless of PrEP initiation

• Screen for hepatitis C virus (HCV) infection

— Treat if active infection exists

— Seek HCV care provider if needed

• Screen and treat as needed for STI’s (syphilis, gonorrhea, chlamydia)

Initiate PrEP Regimen:

• Prescribe TDF/FTC 1 tablet daily for 90 days

— In general, prescribe no more than a 90-day supply, renewable only after patient is confirmed HIV-uninfected

• If active HBV infection is diagnosed, consider using TDF/FTC for both active HBV infection treatment and HIV prevention

• Provide risk-reduction and PrEP medication adherence counseling and condoms

• Every 3 months, perform an HIV antibody test; document negative result

Follow-up: Evaluate and support PrEP medication adherence at each follow-up visit, more often if inconsistent adherence is identified

• At least every 3 months:

— Perform HIV testing and assess for symptoms of acute infection to document HIV-negative status

— Assess risk behaviors and provide risk-reduction counseling and condoms

— Perform STI testing in high risk patients (eg, previous STI, multiple sex partners)

• At least every 6 months:

— Assess renal function. Withhold PrEP if CrCl <60ml/min; consult with nephrologist if CrCl steadily declining (but remains ≥60 ml/min)

— Perform STI testing

• At least every 12 months:

— Evaluate for continued need for PrEP

• Discontinue PrEP if HIV infection is acquired

• Perform confirmatory HIV test. Measure CD4 count, viral load, genotypic HIV viral resistance

• Convert to HIV treatment regimen without waiting for additional test results

• Refer to experienced HIV care provider