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TABLE 2

Summary of Guidance for HIV PrEP Use

Sexually Active YouthYouth Who Inject Drugs
Indicators of substantial risk of acquiring HIV HIV-positive sexual partner HIV-positive injecting partner 
 High HIV prevalence area Sharing injection equipment 
 High HIV prevalence sexual network  
 High number of sexual partners  
 Recent bacterial STI  
 Recurrent PEP use  
 Inconsistent or no barrier protection use  
 Exchanging sex for drugs or money  
 Sexually Active Youth and Youth Who Inject Drugs 
Clinically eligible for PrEP Negative HIV test result before prescribing PrEP  
 No signs/symptoms of acute HIV infection  
 Documented hepatitis B infection and vaccination statusa  
 Normal renal function  
 No medications contraindicated for use with TDF/FTC or TAF/FTC  
Prescription Single daily dose of TDF/FTC, ≤90 day supply  
 Single daily dose of TAF/FTC, ≤90 day supplyb  
Follow-up (every 3 mo) Repeat HIV test  
 Adherence counseling  
 Side effect assessment  
 Risk reduction counseling and support  
 STI symptom assessment and testingc  
 Renal function reassessmentd  
 Pregnancy intention reassessment and testing for female individualse  
 For youth who inject drugs or use other substances, support access to clean needles/syringes and treatment services 
Sexually Active YouthYouth Who Inject Drugs
Indicators of substantial risk of acquiring HIV HIV-positive sexual partner HIV-positive injecting partner 
 High HIV prevalence area Sharing injection equipment 
 High HIV prevalence sexual network  
 High number of sexual partners  
 Recent bacterial STI  
 Recurrent PEP use  
 Inconsistent or no barrier protection use  
 Exchanging sex for drugs or money  
 Sexually Active Youth and Youth Who Inject Drugs 
Clinically eligible for PrEP Negative HIV test result before prescribing PrEP  
 No signs/symptoms of acute HIV infection  
 Documented hepatitis B infection and vaccination statusa  
 Normal renal function  
 No medications contraindicated for use with TDF/FTC or TAF/FTC  
Prescription Single daily dose of TDF/FTC, ≤90 day supply  
 Single daily dose of TAF/FTC, ≤90 day supplyb  
Follow-up (every 3 mo) Repeat HIV test  
 Adherence counseling  
 Side effect assessment  
 Risk reduction counseling and support  
 STI symptom assessment and testingc  
 Renal function reassessmentd  
 Pregnancy intention reassessment and testing for female individualse  
 For youth who inject drugs or use other substances, support access to clean needles/syringes and treatment services 
a

Patients determined to be susceptible to HBV infection should be vaccinated. Patients found to be hepatitis B surface antigen positive should be evaluated for possible treatment either by the clinician providing PrEP care or by linkage to an experienced hepatitis B care provider. Hepatitis B virus infection is not a contraindication to PrEP use. Both TDF and FTC are active against hepatitis B. Hepatitis B virus-monoinfected patients taking TDF or FTC, whether as PrEP or to treat hepatitis B infection, who then stop these medications must have their liver function closely monitored for reactivation of hepatitis B virus replication that can result in hepatic damage.

b

TAF/FTC is not indicated for youth at risk for HIV-1 infection from receptive vaginal sex because the effectiveness in this population has not been evaluated.

c

Includes oral/rectal STI testing for MSM and other eligible youth.

d

At 3 mo and every 6 mo thereafter.

e

Pregnancy and breastfeeding are not contraindications to PrEP prescribing.

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