HIV Preexposure Prophylaxis (PrEP) - Module 5 Prevention of HIV - Lesson 5 HIV Preexposure Prophylaxis (PrEP)

Sep 27, 2026

Module 5 Lesson 5 explains HIV preexposure prophylaxis (PrEP) as a high-impact HIV prevention strategy despite persistently high numbers of new infections in the United States. It summarizes major U.S. and international guidance (CDC, IAS-USA, and USPSTF), identifies who should be considered for PrEP using risk-based criteria, and describes screening approaches. It also outlines FDA-approved PrEP options, including daily oral regimens, on-demand 2-1-1 dosing, and long-acting injectable cabotegravir or lenacapavir, with key eligibility details and renal considerations.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages31

Reading Time1 h 18 min

AccessFree to download

Background

Guidelines for HIV PrEP

Centers for Disease Control and Prevention (CDC)

International Antiviral Society-USA (IAS-USA)

United States Preventive Services Task Force (USPSTF)

Persons to Consider for HIV PrEP

Screening for HIV PrEP

Recommended Regimens and Dosing for HIV PrEP

Tenofovir DF-emtricitabine (Oral)

Tenofovir alafenamide-emtricitabine (Oral)

© National HIV Curriculum PDF created September 27, 2026, 7:39 am HIV Preexposure Prophylaxis (PrEP) This is a PDF version of the following document: Module 5: Prevention of HIV Lesson 5: HIV Preexposure Prophylaxis (PrEP) You can always find the most up-to-date version of this document at [https://www.hiv.uw.edu/go/prevention/preexposure-prophylaxis-prep/core-concept/all](https://www.hiv.uw.edu/go/prevention/preexposure-prophylaxis-prep/core-concept/all). Background Despite decades of efforts to implement HIV-related risk-reduction programs in the United States, the number of new HIV infections has remained greater than 30,000 per year. [ 1 ] It is clear that additional efforts are needed to reduce the number of new HIV infections in the United States. An expanding number of HIV prevention methods are being implemented worldwide, and HIV preexposure prophylaxis (PrEP) is now accepted as an important and highly impactful prevention strategy. [2 , 3 ] Most often, HIV PrEP is used to prevent sexual transmission of HIV, but it has also been used to prevent transmission of HIV associated with injection drug use. There are now three types of HIV PrEP used in the United States: (1) daily oral HIV PrEP with either oral tenofovir DF-emtricitabine or oral tenofovir alafenamide-emtricitabine,(2) on-demand (2-1-1) dosing using oral tenofovir DF-emtricitabine, and (3) long-acting injectable HIV PrEP (using intramuscular cabotegravir [cabotegravir-IM] or subcutaneous lenacapavir [lenacapavir-SQ]) ( Figure 1 ). [4 , 5 ] Guidelines for HIV PrEP Centers for Disease Control and Prevention (CDC) : In December 2021, the CDC and the U. S. Public Health Service (USPHS) published an updated 2021 CDC PrEP Clinical Practice Guideline along with an updated Clinical Providers' Supplement. [4 ,6 ] In 2025, the CDC provided guidance for the use of lenacapavir for HIV PrEP. [ 5 ] International Antiviral Society-USA (IAS-USA) : In December 2022, the International Antiviral Society-USA Panel (IAS-USA) updated the Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults guidelines, which include recommendations for prescribing oral and injectable HIV PrEP. [ 7 ] The IAS-USA issued a brief update in 2025 that focused on the use of lenacapavir-SQ for HIV PrEP. United States Preventive Services Task Force (USPSTF) : In August 2023, the USPSTF gave a Grade A recommendation for the use of HIV PrEP by clinicians to reduce HIV acquisition in persons at risk of acquiring HIV. [8 ,9 ] Persons to Consider for HIV PrEP In the United States, it is estimated that approximately 1.2 million persons have an HIV PrEP indication. [4 , 10 ] Although HIV PrEP use has increased in the United States in recent years, data from 2022 indicate that only 26% of individuals in the United States with an HIV PrEP indication were prescribed HIV PrEP ( Figure 2 ). [ 11 , 12 ] In addition, significant differences in access to and receipt of HIV PrEP persist based on socioeconomic and demographic factors, such as region of residence, sex, age, race, ethnicity, insurance status, residing in a state with expanded Medicaid or an HIV PrEP drug assistance program, as well as other factors. Screening for HIV PrEP Health care professionals should provide all sexually active adult and adolescent persons with information regarding HIV PrEP. [4 ] A brief sexual history is recommended to assess the risk of acquiring HIV and to identify potential indications for HIV PrEP. Specific indications for HIV PrEP, as recommended in the 2021 CDC PrEP Clinical Practice Guideline, are outlined as follows. [4 ] Sexually Active Adults and Adolescents who Weigh at Least 35 kg Anal or vaginal sex in the past 6 months AND any of the following: Sex partner with HIV (especially if the person with HIV has an unknown or detectable viral load) Bacterial sexually transmitted infection within the past 6 months (gonorrhea, chlamydia, and syphilis for men who ha

FAQs

What is HIV preexposure prophylaxis (PrEP) used for?

HIV PrEP is used to reduce the risk of acquiring HIV, most often for preventing sexual transmission and also for preventing transmission associated with injection drug use.

Which organizations issue clinical guidance for HIV PrEP?

The CDC, IAS-USA, and the USPSTF provide recommendations and guidance for PrEP use, including updates on clinical practice and medication considerations.

What oral and injectable PrEP options are FDA-approved in the United States?

FDA-approved options include daily oral tenofovir DF-emtricitabine or tenofovir alafenamide-emtricitabine, on-demand (2-1-1) dosing with oral tenofovir DF-emtricitabine as an off-label approach for select individuals, and long-acting injectable cabotegravir or long-acting injectable lenacapavir.

Sep 27, 2026

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