B8-082 PrEP

Question 1

oral medications approved for PrEP [2]

Answer 1

truvada
descovy

(daily)

Question 2

IM medication approved for PrEP [1]

Answer 2

apretude

(once every 2 months; very difficult to get approved though)

Question 3

oral PrEP med that is less toxic to bones and kidneys

Answer 3

descovy

(prodrug, spends more time in cells less in plasma)

Question 4

descovy can be used with a CrCl of […]

truvada requires a CrCl of […]

Answer 4

descovy: 30 (prodrug, less toxic)

truvada: 60

Question 5

[truvada/descovy] is associated with weight gain

Answer 5

descovy

Question 6

[truvada/descovy] approved for all patients 13+

Answer 6

turvada

Question 7

[truvada/descovy] only approved for males as assigned at birth

Answer 7

descovy

Question 8

[truvada/descovy/apretude]
less expensive, more likely to be approved by insurace

Answer 8

truvada

Question 9

[truvada/descovy/apretude]
smaller pill

Answer 9

descovy

Question 10

[truvada/descovy/apretude]
better kidney/bone health over long term use

Answer 10

descovy

Question 11

[truvada/descovy/apretude]
lower risk of weight gain

Answer 11

truvada

Question 12

[truvada/descovy/apretude]
decreases pill burden

Answer 12

apretude (IM)

Question 13

[truvada/descovy/apretude]
higher efficacy

Answer 13

apretude

(trial over truvada was stopped early due to effectiveness, but hard to get insurance to approve)

Question 14

[truvada/descovy/apretude]
least impact of bone/renal disease

Answer 14

apretude

Question 15

only medication option for ciswomen/transmen if apretude is not approved

Answer 15

truvada

Question 16

appropriate for younger, healthy individuals at low risk of renal/bone disease

Answer 16

truvada

Question 17

[truvada/descovy]

best for individuals at risk or have underlying renal/bone disease

Answer 17

descovy

Question 18

best choice for individuals with significant renal impairment or osteoporosis

Answer 18

apretude

Question 19

contraindications for prescribing PrEP [3]

Answer 19

HIV +
HIV exposure <72 hours (PEP instead)
renal disease

Question 20

cautions for prescribing PrEP [5]

Answer 20

recent viral syndrome (test for HIV)
Hep B infection
kidney disease
osteoporosis
pregnancy/breastfeeding (can have PrEP if risk of HIV is high)

Question 21

5 Ps of taking a sexual history

Answer 21

Partners
Practices
Past History of STIs
Protection of STIs
Pregnancy intention

Question 22

PrEP requires […] days to be effective for anal sex and […] days to be effective for vaginal sex

Answer 22

PrEP requires [7] days to be effective for anal sex and [20] days to be effective for vaginal sex

Question 23

HBsAg –
HBsAb –
HBcAb –

Answer 23

not immune, not protected

(need vaccine)

Question 24

HBsAg –
HBsAb +
HBcAb +

Answer 24

previous infection
protected, no vaccine needed

Question 25

HBsAg -- HBsAb + HBcAb --

Answer 25

previously vaccinated

Question 26

HBsAg + HBsAb -- HBcAb +

Answer 26

infected

Question 27

HBsAg -- HBsAb -- HBcAb +

Answer 27

past exposure, not immune more testing is needed

Question 28

patients receiving PrEP should follow up every [...] months

Answer 28

3 (to ensure HIV - status continues)

Question 29

approximately when after exposure would you expect a patient to have a positive HIV result? (assume 4th gen test, he said that's what KU uses)

Answer 29

15-20 days

Question 30

best PrEP for individuals having less frequent sex and those who can anticipate having sex only indicated for patients engaging in anal sex

Answer 30

on demand PrEP (2-1-1) (two pills 24 hrs prior, 1 pill every 24 hrs after)

Question 31

an HIV+ individual with undetectable viral load [can/cannot] transmit the virus to others

Answer 31

cannot U=U

Question 32

in order to qualify for U=U, viral load must remain undetectable for [...] months and continue to be sustained by daily medication

Answer 32

6 (important to ensure partner is undetectable and correctly taking medications)

Question 33

PrEP is [...]% effective for sexual contact and [...]% effective for injection drug use

Answer 33

PrEP is [99]% effective for sexual contact and [74]% effective for injection drug use

Question 34

[...] is rarely a barrier to PrEP

Answer 34

cost

Question 35

descovy is currently only approved for what gender?

Answer 35

cismen transwomen (people assigned male sex at birth; limited due to current study data)

Question 36

approved for all individuals over 13 [2]

Answer 36

truvada apretude

Question 37

can be used at any creatinine clearance

Answer 37

apretude

Question 38

can only be used if CrCl is over 60

Answer 38

truvada

Question 39

approved if CrCl is over 30

Answer 39

descovy

Question 40

initial labs to get before starting PrEP [7]

Answer 40

HIV Hep B Hep C CMP Syphilis GC/CT pregnancy test

Question 41

HBsAg positive signals

Answer 41

infection

Question 42

HBsAb positive signals

Answer 42

immunity (previous infection or vaccination)

Question 43

HBcAb positive signals

Answer 43

previous exposure (could be vaccinate or infection)

Question 44

patients should be seen for follow up [...] after starting PrEP

Answer 44

3 months

Question 45

follow up labs after initiating PrEP

Answer 45

HIV GC/CT, syphilis if new risk BMP (can space to 6 months after initial 3 month is normal)

Question 46

PEP must be started within [...] of exposure

Answer 46

72 hrs

Question 47

IV drug use [is/is not] an indication for PrEP

Answer 47

is

Question 48

if the Hep B results come back positive, can the patient still start PrEP?

Answer 48

yes truvada and descovy actually treat Hep B

Question 49

options for PrEP for a cisfemale with low CrCl

Answer 49

**apretude** can consider off label use of descovy if insurance does not approve

Question 50

indications for PEP [2]

Answer 50

known HIV exposure unknown exposure with high risk factors

Question 51

truvada + dolutegravir for 4 weeks is

Answer 51

PEP (can transition to PrEP after)

Question 52

should PrEP be delayed if the STI results come back positive?

Answer 52

no

Question 53

does PrEP interact with any form of birth control?

Answer 53

no

Question 54

is PrEP safe in pregnant/breastfeeding mothers?

Answer 54

yes

Question 55

does PrEP protect against HPV?

Answer 55

no best protection from HPV is vaccination and condom use

Question 56

trudava can be used with a CrCl greater than

Answer 56

60

Question 57

descovy can be used with a CrCl greater than

Answer 57

30

Question 58

what is the window period for a 4th gen IgM and IgG Ab and p24Ag test?

Answer 58

15-20 days

Question 59

what is the window period for an HIV viral load?

Answer 59

10-15 days

Question 60

a positive Hep B core Ab indicates

Answer 60

previous exposure

Question 61

a positive Hep B surface Ag indicates

Answer 61

infection is present

Question 62

components of "Ending the HIV Epidemic: A Plan for America"?

Answer 62

Diagnose as early as possible Treat rapidly Prevent new transmissions Respond quickly to outbreaks

Question 63

people in mutually monogamous relationships with an HIV negative partner [are/are not] good candidates for PrEP

Answer 63

are not (unless they ask to be treated)