January 21, 2014 Guidance for the Use of Pre-Exposure Prophylaxis to Prevent HIV Transmission Related Links HIV Prophylaxis Following Non-Occupational Exposure I Might Have Been Exposed to HIV....What Should I Do? Diagnosis and Management of Acute HIV Infection Acute HIV Infection in Pregnancy Prevention with Positives: Integrating HIV Prevention into HIV Primary Care Contributors Page Quick Links New York State Department of Health AIDS Institute Clinical Education Initiative HIV Training NY HEALTHQUAL International HIVQUAL-US eHIVQUAL National Quality Center in+care Campaign PozKit: A Prevention with Positives Toolkit for Clinicians hivguidelines.org HIV Clinical Guidelines Program About Us Email Announcement Archives Join Our List Dear Colleague: The New York State Department of Health AIDS Institute (NYSDOH AI) supports the addition of pre-exposure prophylaxis (PrEP) to the menu of evidence-based interventions to prevent HIV transmission. To promote effective use of this biomedical intervention, the Office of the Medical Director, is pleased to announce the release of a new guidance document for the use of pre-exposure prophylaxis (PrEP). The document includes a series of tables and checklists that can be easily used at the point of care. These include the following: Candidates, Contraindications, and Considerations Table 1 lists individuals in certain risk categories who may be potential candidates for PrEP. Table 2 lists contraindications to PrEP, which include documentation of HIV infection, creatinine clearance <60 mL/min, and lack of readiness to adhere to PrEP. Table 3 lists important considerations before prescribing PrEP, such as chronic hepatitis B infection, use during pregnancy or attempts to conceive, use of concomitant nephrotoxic drugs, whether the patient is an adolescent, and whether the patient has osteopenia, osteomalacia, or osteoporosis. Pre-Prescription Checklists Table 4 includes a checklist of more in-depth items to assess after determining that an individual may be a candidate for PrEP. These assessments will provide important information about the individual prevention needs of the patient. Table 5 lists topics for patient education before prescribing PrEP. Patient education is critical for shared decision-making and the success of PrEP as part of the prevention plan. Table 6 lists the laboratory tests that should be obtained at the pre-prescription visit. Prescribing Recommendations Table 7 includes important prescribing information, such as dosing, prescription refill information, and side effects. Follow-Up and Monitoring Visits Figure 1 provides a flow chart for the elements of each visit throughout the first year of initiating PrEP, starting with the pre-prescription visit and ending with the 12-month visit. Table 8 lists the elements to assess at each follow-up visit as well as a list of laboratory tests to obtain and the frequency of those tests. Discontinuation of PrEP Table 9 lists scenarios that should prompt discontinuation of PrEP. Discontinuation of tenofovir/emtricitabine in patients with chronic active hepatitis B virus can cause exacerbations of hepatitis B.