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HIV prevention — USMLE Step 3 MCQ

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HardAmbulatory Medicine / Primary CareHIV preventionUSMLE Step 3

A man without HIV requests PrEP. HIV antigen/antibody and RNA tests are negative. Estimated creatinine clearance is 24 mL/min and stable; hepatitis B testing is negative. Which regimen is most appropriate?

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Correct answer: D — Use long-acting injectable cabotegravir with injection-visit HIV testing

The best answer is “Use long-acting injectable cabotegravir with injection-visit HIV testing”. Both oral tenofovir regimens require higher renal function than this patient has. Injectable cabotegravir does not require kidney monitoring and is the recommended PrEP option for serious kidney disease after HIV infection has been excluded. Oral tenofovir-containing PrEP requires renal thresholds; injectable cabotegravir is recommended instead for serious kidney disease with estimated creatinine clearance below 30 mL/min.

Reference: CDC HIV Nexus: Clinical Guidance for PrEP: https://www.cdc.gov/hivnexus/hcp/prep/index.html