Antiretroviral regimens for HIV PrEP

Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine (ASHM), 2021Choopanya, 2013McCormack, 2016Molina, 2015Murnane, 2013Riddell, 2018

HIV pre-exposure prophylaxis (PrEP) is available as an oral regimen, taken daily or on demand. Daily HIV PrEP is appropriate for all patients in whom PrEP is suitable, but on-demand HIV PrEP should only be offered to cis-gender men who have sex with men because of a lack of data in other at-risk groups. For cis-gender men who have sex with men, offer on-demand PrEP when all of the following apply:

• a person expresses a preference for this regimen
• the person has at-risk sex less than twice a week
• sex can be delayed for 2 hours.

Cabotegravir long-acting injection has been shown to be superior to daily oral tenofovir disoproxil fumarate+emtricitabine for HIV PrEP but is not currently available on the Pharmaceutical Benefits Scheme (PBS)Delany-Moretlwe, 2022Landovitz, 2021. The risk of integrase strand transfer inhibitor (INSTI) resistance in breakthrough HIV infections needs to be considered in people who use cabotegravir for PrEP – seek expert advice.