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HIV preexposure prophylaxis

CDC HIV PrEP eligibility, baseline exclusion of acute HIV, oral and injectable choices, kidney and hepatitis B safety and continuing monitoring.

JurisdictionUnited States
Source check2026-08-20
Clinical reviewiatroX editorial team 路 Clinical editorial review 路 reviewed 2026-08-20 路 due 2027-08-20
AudienceUnited States healthcare professionals
This is an iatroX educational summary of named United States sources, not an official guideline. It does not replace the complete source documents, local policy, specialist advice or clinical judgement. Use the named authority, current FDA labeling, applicable state law, payer rules and local protocol where relevant.

Scope of this summary

Adults and adolescents without HIV who may benefit from preexposure prophylaxis through sexual or injection exposure. This page covers the current CDC clinical workflow but does not replace product labeling, pediatric specialist care or HIV treatment when infection is present.
sources for this section:CDC HIV PrEP guidance

The Bottom Line

  • Tell every sexually active adult and adolescent about PrEP and prescribe it to anyone without HIV who asks for it after safe evaluation; disclosure of a named risk factor should not be a gate to prevention.
  • Exclude established and acute HIV before starting or continuing PrEP using the CDC algorithm, including blood antigen鈥揳ntibody and HIV-1 RNA testing when indicated by symptoms or recent PrEP or PEP exposure.
  • Current options are daily oral emtricitabine/tenofovir disoproxil fumarate, daily emtricitabine/tenofovir alafenamide for sexual transmission excluding receptive vaginal exposure, and long-acting injectable cabotegravir for sexual transmission.
  • Check kidney function before oral tenofovir PrEP, hepatitis B serology before either oral combination and lipids before emtricitabine/tenofovir alafenamide; injectable cabotegravir does not require kidney monitoring.
  • High adherence makes PrEP highly effective, but prevention visits must also include HIV testing, STI screening, adherence support, reproductive care, vaccinations and harm-reduction services as applicable.
sources for this section:CDC HIV PrEP guidance

Practical clinical workflow

1
Take a confidential sexual and injection history, ask about acute retroviral symptoms and recent exposures, PrEP or PEP, and discuss daily oral versus injection preferences without requiring the patient to prove risk.
2
Follow the CDC baseline HIV algorithm and screen for gonorrhea and chlamydia at exposed sites, syphilis, kidney function for oral PrEP, hepatitis B for tenofovir combinations and pregnancy or lipids where relevant.
3
Select a regimen by exposure route, kidney and hepatitis status, pregnancy context, age and weight, adherence preference, interaction and access, then explain time to protection and what to do after missed doses or injections.
4
For oral PrEP, repeat HIV antigen鈥揳ntibody and HIV-1 RNA testing at least every three months and issue no more than a 90-day supply; follow the CDC injection and testing calendar for cabotegravir.
5
At each follow-up assess adherence, adverse effects, new exposure, STI needs and desire to continue; plan safe discontinuation, including hepatitis B follow-up after oral tenofovir and alternative protection through the cabotegravir tail.
sources for this section:CDC HIV PrEP guidance

Safety boundaries and escalation

  • Do not give two-drug PrEP to a person with HIV or unresolved discordant testing because incomplete therapy can select resistance; link confirmed infection to immediate full treatment.
  • Use current estimated-creatinine-clearance thresholds for each oral product and monitor more often with older age, lower baseline function, diabetes, hypertension or nephrotoxic medicines.
  • Stopping oral tenofovir in active hepatitis B can cause hepatic flare, while missed cabotegravir injections create a prolonged pharmacokinetic tail in which infection and resistance must be prevented and tested for.
  • A substantial exposure within the previous 72 hours may require immediate three-drug PEP first; do not wait for a routine PrEP appointment.
sources for this section:CDC HIV PrEP guidance

Localization

CDC HIV Nexus and current FDA labels define US options. State minor-consent and confidentiality law, pharmacy access, payer coverage and syringe-service legality vary. CDC describes 2-1-1 F/TDF as off-label and not CDC-recommended even though selected adult gay and bisexual men may receive it through expert shared decision-making; do not present it as a universal regimen.
sources for this section:CDC HIV PrEP guidance

Source documents

Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.

  1. Centers for Disease Control and PreventionClinical Guidance for PrEPCurrent HIV Nexus clinician guidance 路 accessed 2026-08-20
    view source
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