Pre-Exposure Prophylaxis: A New Strategy in HIV Prevention

by Varsha Koripella, M2, Wayne State Medical School, Terri L. Wilder, MSW, Mt. Sinai Institute for Advanced Medicine, Antonio E. Urbina, MD, Mt. Sinai Institute for Advanced Medicine

This is part 2 in a 4 part series of articles detailing New York’s efforts to combat HIV through PrEP and other regiments

Although the total number of new HIV infections in NYS is decreasing, rates continue to rise in some populations. For these persons, an effective intervention may be pre-exposure prophylaxis, or PrEP, a once-daily pill consisting of 300 mg tenofovir and 200 mg emtricitabine.

Who should be prescribed PrEP?

HIVPrEP is beneficial for individuals who are HIV-negative, but at ongoing high risk for HIV infection, namely men who have sex with men, injection drug users, and serodiscordant couples where one partner is HIV-positive and the other is HIV-negative. It is important that a negative HIV test result be confirmed immediately before initiation of PrEP. Since PrEP is a prevention tool to use during high-risk periods and not a life-long intervention, the length of use will depend on the individual’s risk behaviors.


Before prescribing PrEP, providers must explain to the patient how the medication works and the need for strict adherence. Patients must also understand that PrEP is not a sole intervention, but part of a comprehensive prevention plan that includes counseling about the following: consistent condom use, safer-sex practices, the importance of frequent HIV testing and, for individuals in serodiscordant relationships, the importance of suppressive ART (anti-retroviral treatment) for the HIV-infected partner.

Follow-Up and Monitoring

The first prescription of PrEP should be for 30 days. A follow-up visit should be scheduled at 2 weeks and 30 days to assess adherence and tolerance. At the 30-day visit, a prescription for 60 days may be given and, after that visit, prescriptions for 90 days may be given as long as the patient is adherent. Follow-ups should occur at least every 90 days. At each follow-up, the medical provider must give an HIV test, provide risk-reduction counseling, and manage side-effects.

Discontinue PrEP immediately if the patient receives a positive HIV test result, develops renal disease, is non-adherent or using the medication for unintended purposes, or has reduced risk behaviors to the extent that PrEP is no longer needed.

Are you up-to-date on PrEP?

The New York State (NYS) Department of Health Clinical Education Initiative (CEI) provides free trainings on PrEP for medical providers in NYS. To request a training or to view on-line PrEP courses, please visit To speak with a clinician experienced in managing PrEP, call the CEI line toll-free at 1-866-637-2342.

The complete NYS DOH PrEP guidelines can be found at


  1. HIV Clinical Resource. NYS Department of Health AIDS Institute, Jan. 2014. Web. 15 June 2015. <;

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