Considerations before starting HIV PrEP
Australasian Society for HIV Viral Hepatitis and Sexual Health Medicine (ASHM), 2021
Before prescribing pre-exposure prophylaxis (PrEP) for people who have been assessed as suitable, perform baseline testing for:
- HIV – start PrEP within 7 days of a negative HIV test1. If the patient has signs or symptoms consistent with acute HIV infection, do not start PrEP until HIV infection has been excluded
- hepatitis A, B and C viruses – immunise susceptible priority patients2 against hepatitis A and B. If a patient has serological evidence of current hepatitis B infection, do not prescribe on-demand PrEP; daily PrEP can be used but the patient should be counselled on the importance of adherence to reduce the risk of developing hepatitis B resistance (see also Hepatitis B and HIV co-infection)
- sexually transmissible infections – see the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) STI Management Guidelines
- kidney function (including protein-to-creatinine ratio) – PrEP is not recommended for patients with an estimated glomerular filtration rate (eGFR) less than 60 mL/min because there is a lack of data in this population
- pregnancy – if applicable.
Provide advice about reducing the risk of HIV and sexually transmissible infections and, if applicable, discuss safer injecting practices.
Assess the person’s need for HIV postexposure prophylaxis (PEP) if exposure to HIV may have occurred in the 72 hours before starting PrEP (see Management of suspected or confirmed exposure to HIV).
Ensure the patient can attend regular follow-up appointments, at least every 3 months, for ongoing monitoring.