-History & Physical exam done above.
–Current CDC PrEP Guidelines reviewed with the patient.
–HIV test: Will document negative HIV test result before prescribing PrEP
-Symptom assessment: Patient has no signs/symptoms of acute HIV infection.
–Renal function: CMP to document normal renal function before starting prep.
-Med-Review: Medication review doesn’t show any contraindicated medications.
-Hep B status: Will documented hepatitis B virus infection and vaccination status.
–Truvada: Will Rx Daily, continuing, oral doses of Truvada, ≤90 day supply
-F/u: Will schedule f/u visits at least every 3 months to provide: HIV test, medication adherence counseling, behavioral risk reduction support, side effect assessment, and STI symptom assessment.
-At 3 months and every 6 months thereafter, assess renal function.
-Every 3-6 months, I will test for bacterial STIs
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“Emtricitabine/tenofovir is the only currently approved regimen shown to be effective for HIV preexposure prophylaxis (PrEP) (SOR A). This patient has multiple sexual partners, including one at high risk for HIV infection due to intravenous drug use, and thus should be offered PrEP (SOR C). In patients without signs of acute HIV, PrEP may be initiated after documentation of negative fourth-generation HIV antibody/antigen testing, normal renal function, and hepatitis B infection and immunization status. Tenofovir can be toxic to the kidneys and is not recommended in patients with an estimated glomerular filtration rate <60 mL/min/1.73 m2. Emtricitabine and tenofovir are both also active against hepatitis B virus (HBV) infection, so the use of PrEP in patients with active HBV must be carefully considered. If a patient with active HBV stops taking PrEP, reactivated HBV can cause liver damage. Patients susceptible to HBV infection should be immunized. Hepatitis C testing would be prudent in this case, but the results are not needed to begin therapy with emtricitabine/tenofovir.” ABFM
References
https://www.cdc.gov/hiv/guidelines/preventing.html [Scroll to the bottom to find the PrEP Guidelines link]
Click to access cdc-hiv-PrEPguidelines-2017.pdf
Preexposure prophylaxis (PrEP) for HIV prevention: The primary care perspective. J Am Board Fam Med 2016;29(1):143-151.