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HIV preexposure prophylaxis — ABIM Board MCQ

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EasyInfectious DiseaseHIV preexposure prophylaxisABIM Board

A 29-year-old man reports ongoing condomless anal sex with male partners and was treated for rectal gonorrhea 3 months ago. He has no symptoms suggestive of acute HIV infection. HIV antigen-antibody testing and HIV-1 RNA testing are negative, and his estimated creatinine clearance is 96 mL/min. Which of the following should be recommended to reduce his risk of acquiring HIV?

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Correct answer: E — Begin daily oral tenofovir disoproxil fumarate-emtricitabine preexposure prophylaxis

Daily oral tenofovir disoproxil fumarate-emtricitabine is an appropriate HIV preexposure prophylaxis regimen. This patient has ongoing sexual exposure risk, including condomless anal sex and rectal gonorrhea within the past 6 months. HIV infection has been excluded, and his estimated creatinine clearance of 96 mL/min exceeds the threshold required for F/TDF. Postexposure prophylaxis is reserved for discrete potential exposures evaluated within 72 hours and is not the preferred routine strategy for recurrent exposure. Azithromycin does not prevent HIV acquisition and may promote antimicrobial resistance. No HIV vaccine is currently available. Other approved PrEP formulations exist, but F/TDF is the only recommended PrEP regimen offered among these choices.

Reference: Centers for Disease Control and Prevention. HIV Nexus: Clinical Guidance for PrEP, Oral PrEP section. Updated April 30, 2026. https://www.cdc.gov/hivnexus/hcp/prep/index.html