Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis

Tan, Darrell H. S.; Hull, Mark; Yoong, Deborah; Tremblay, Cécile; O’Byrne, Patrick; Thomas, Réjean; Kille, Julie; Baril, Jean‐Guy; Cox, Joseph; Giguère, Pierre; Harris, Marianne; Hughes, Christine; MacPherson, Paul; O’Donnell, Shannon; Reimer, Joss; Singh, Ameeta E.; Barrett, Lisa; Bogoch, Isaac I.; Jollimore, Jody; Lambert, Gilles; Lebouché, Bertrand; Metz, Gila; Rogers, T.; Shafran, Stephen D.

doi:10.1503/cmaj.170494

Cited by 166 publications

(293 citation statements)

References 32 publications

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“…PEP is typically initiated when the exposure risk is moderate to high4 (table 1) and when the source has a non-negligible risk of HIV,1256 such as with condomless anal insertive or receptive intercourse or sharing of drug injecting paraphernalia 3456. When adherence or recent viral load data are unknown, PEP is frequently offered and subsequently discontinued during follow-up if additional data reveal the source to be non-infectious.…”

Section: What You Should Covermentioning

confidence: 99%

“…PEP regimens typically comprise three antiretroviral drugs that are started within 72 hours after a potential or confirmed HIV exposure and continued for 28 days 1256. Common PEP drug regimens include a combination tablet of tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC 300mg/200mg once daily) and an integrase inhibitor such as raltegravir (400 mg twice daily).…”

Section: What You Should Domentioning

confidence: 99%

“…Empiric treatment for sexually transmitted infections (STIs) is typically provided to patients who have experienced sexual assault and occasionally to others in whom risk is high 125. STI treatment should adhere to local guidelines.…”

Section: What You Should Domentioning

confidence: 99%

“…Perform an additional HIV screen at six months if hepatitis C was acquired from the inciting exposure, as acute hepatitis C infection may delay HIV seroconversion 125…”

Section: What You Should Domentioning

confidence: 99%

“…Twenty six hours previously, he had anal receptive intercourse without a condom with a man of unknown HIV serostatus. He had immediate testing for HIV (using a fourth generation antibody/antigen assay as recommended 12 ), hepatitis B and C serologies, syphilis serology, and urine nucleic acid amplification tests for gonorrhoea and chlamydia. In the emergency department he received a three day supply of combined emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) (one tablet, daily) plus raltegravir (400 mg twice daily).…”

mentioning

confidence: 99%

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HIV post-exposure prophylaxis (PEP)

Siedner

Tumarkin

Bogoch

2018

BMJ

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Section: What You Should Covermentioning

confidence: 99%

Section: What You Should Domentioning

confidence: 99%

Section: What You Should Domentioning

confidence: 99%

“…Perform an additional HIV screen at six months if hepatitis C was acquired from the inciting exposure, as acute hepatitis C infection may delay HIV seroconversion 125…”

Section: What You Should Domentioning

confidence: 99%

mentioning

confidence: 99%

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HIV post-exposure prophylaxis (PEP)

Siedner

Tumarkin

Bogoch

2018

BMJ

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Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Saag

Benson

Gandhi

et al. 2018

JAMA

514

287

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IMPORTANCE Antiretroviral therapy (ART) is the cornerstone of prevention and management of HIV infection. OBJECTIVE To evaluate new data and treatments and incorporate this information into updated recommendations for initiating therapy, monitoring individuals starting therapy, changing regimens, and preventing HIV infection for individuals at risk. EVIDENCE REVIEW New evidence collected since the International Antiviral Society–USA 2016 recommendations via monthly PubMed and EMBASE literature searches up to April 2018; data presented at peer-reviewed scientific conferences. A volunteer panel of experts in HIV research and patient care considered these data and updated previous recommendations. FINDINGS ART is recommended for virtually all HIV-infected individuals, as soon as possible after HIV diagnosis. Immediate initiation (eg, rapid start), if clinically appropriate, requires adequate staffing, specialized services, and careful selection of medical therapy. An integrase strand transfer inhibitor (InSTI) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) is generally recommended for initial therapy, with unique patient circumstances (eg, concomitant diseases and conditions, potential for pregnancy, cost) guiding the treatment choice. CD4 cell count, HIV RNA level, genotype, and other laboratory tests for general health and co-infections are recommended at specified points before and during ART. If a regimen switch is indicated, treatment history, tolerability, adherence, and drug resistance history should first be assessed; 2 or 3 active drugs are recommended for a new regimen. HIV testing is recommended at least once for anyone who has ever been sexually active and more often for individuals at ongoing risk for infection. Preexposure prophylaxis with tenofovir disoproxil fumarate/emtricitabine and appropriate monitoring is recommended for individuals at risk for HIV. CONCLUSIONS AND RELEVANCE Advances in HIV prevention and treatment with antiretroviral drugs continue to improve clinical management and outcomes for individuals at risk for and living with HIV.

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Population‐level impact of expanding PrEP coverage by offering long‐acting injectable PrEP to MSM in three high‐resource settings: a model comparison analysis

et al. 2023

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Introduction: Long-acting injectable cabotegravir (CAB-LA) demonstrated superiority to daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for HIV pre-exposure prophylaxis (PrEP) in the HPTN 083/084 trials. We compared the potential impact of expanding PrEP coverage by offering CAB-LA to men who have sex with men (MSM) in Atlanta (US), Montreal (Canada) and the Netherlands, settings with different HIV epidemics. Methods: Three risk-stratified HIV transmission models were independently parameterized and calibrated to local data. In Atlanta, Montreal and the Netherlands, the models, respectively, estimated mean TDF/FTC coverage starting at 29%, 7% and 4% in 2022, and projected HIV incidence per 100 person-years (PY), respectively, decreasing from 2.06 to 1.62, 0.08 to 0.03 and 0.07 to 0.001 by 2042. Expansion of PrEP coverage was simulated by recruiting new CAB-LA users and by switching different proportions of TDF/FTC users to CAB-LA. Population effectiveness and efficiency of PrEP expansions were evaluated over 20 years in comparison to baseline scenarios with TDF/FTC only. Results: Increasing PrEP coverage by 11 percentage points (pp) from 29% to 40% by 2032 was expected to avert a median 36% of new HIV acquisitions in Atlanta. Substantially larger increases (by 33 or 26 pp) in PrEP coverage (to 40% or 30%) were needed to achieve comparable reductions in Montreal and the Netherlands, respectively. A median 17 additional PYs on PrEP were needed to prevent one acquisition in Atlanta with 40% PrEP coverage, compared to 1000+ in Montreal and 4000+ in the Netherlands. Reaching 50% PrEP coverage by 2032 by recruiting CAB-LA users among PrEP-eligible MSM could avert >45% of new HIV acquisitions in all settings. Achieving targeted coverage 5 years earlier increased the impact by 5-10 pp. In the Atlanta model, PrEP expansions achieving 40% and 50% coverage reduced differences in PrEP access between PrEP-indicated White and Black MSM from 23 to 9 pp and 4 pp, respectively. Conclusions: Achieving high PrEP coverage by offering CAB-LA can impact the HIV epidemic substantially if rolled out without delays. These PrEP expansions may be efficient in settings with high HIV incidence (like Atlanta) but not in settings with low HIV incidence (like Montreal and the Netherlands).

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Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis

Cited by 166 publications

References 32 publications

HIV post-exposure prophylaxis (PEP)

HIV post-exposure prophylaxis (PEP)

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Population‐level impact of expanding PrEP coverage by offering long‐acting injectable PrEP to MSM in three high‐resource settings: a model comparison analysis

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