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Prescribing PrEP in Asia

CME

PrEP to Prevent HIV: Prescribing PrEP in Asia

Physicians: maximum of 1.00 AMA PRA Category 1 Credit

Released: June 09, 2025

Expiration: June 08, 2026

Jakkrapatara Boonruang
Jakkrapatara Boonruang, MD
CME/CE Information

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Individualization of PrEP

Now, let's move on to individualization of PrEP use.

There are multitudes of factors that play significant roles in determining which PrEP regimen is right for an individual. It is also important to bear in mind that these factors can change with time. Therefore, how people take PrEP should also change according to the dynamic of their lifestyles.18

The first factor to consider is personal preferences. Some people may prefer oral PrEP instead of injections because they don't want to face the injection-site reactions or have a fear of needles.18

Second, patients’ lifestyles, especially their sexual lifestyles, can affect which regimen is best suited for them.18

Finally, living circumstances can impact PrEP choice. For example, are patients residents of the country they are living in, or are they traveling a lot? Is it hard for them to physically access healthcare services?18

These considerations are very important for determining the most suitable PrEP regimen for an individual.

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Dosing Regimens for Daily Oral PrEP with TDF/FTC

Once a PrEP regimen has been chosen, dosing regimens may be further individualized, based on each specific population.

For all populations, PrEP with TDF/emtricitabine (FTC) is a daily oral. The difference is in how long the pill needs to be taken before it is effective and how long the pill need to be taken after their last potential exposure to HIV.

Let's start with cisgender men and trans- and gender-diverse people assigned male at birth, who are not using gender-affirming hormone therapy. For people in these populations, it takes 1 double dose on the first day to reach protective levels, and if they decide to stop using PrEP, they should take 1 dose per day until 2 days after their last potential exposure to HIV.19

For cisgender women and trans- and gender-diverse people assigned male at birth, who are using gender-affirming hormone therapy, it takes 7 days of daily dosing to reach protective levels, and if they decide to stop using PrEP, they should take 1 dose per day until 7 days after their last potential exposure.19

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Dosing Regimens for Oral On-demand PrEP With TDF/FTC

As the diagram on the left shows, for people who are eligible for on-demand or event-driven PrEP, the procedure for initiating and halting PrEP is the same. This is true regardless of whether the intention is to use daily oral or event-driven PrEP.19

This diagram also visually illustrates how people who are not eligible for on-demand PrEP should start and stop daily oral PrEP.19

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Uptake for Daily and Event-driven PrEP in the Asia-Pacific Region

The data in this table demonstrate that there are varying levels of demand for different PrEP regimens. Although most people prefer daily oral PrEP, a substantial proportion prefer event-driven.22

It is important to let your patients know about all PrEP options so they can choose what is best for them.

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Preference for Daily and Event-driven PrEP in the Asia-Pacific Region

The data here demonstrate that although people have a preferred PrEP modality, many are also interested in other regimens. That is, some people who are using daily PrEP also want to have the option to use event-driven PrEP, and vice versa—those who are using event-driven PrEP have interest in being able to switch back to daily PrEP as well.22

Thus, it is very important for HCPs and patients to know how to start and stop using PrEP according to their specific population and risk profiles.22

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Clinical Considerations to Guide PrEP Initiation

Finally, there are clinical considerations that should be accounted for before prescribing PrEP.

First, the risk of drug resistance is low, but is greatest when PrEP is taken during acute HIV infection. This highlights why 1-month follow-up is crucial to detect acute HIV infection and prevent drug resistance.19,23

Second, although dose adjustments are not required for concurrent use of PrEP and contraception, the available data suggest that gender-affirming hormone therapy, particularly estradiol, can reduce the concentrations of serum tenofovir. Thus, whether or not patients are taking gender-affirming hormone therapy should be considered during PrEP initiation.18

To ensure adequate levels of drug for protection, transgender and gender diverse individuals who are using gender-affirming hormone therapy must take PrEP for at least 7 days before HIV exposure and at least 7 days afterwards.18

Uncertainties surrounding drug–drug interactions between gender-affirming hormone therapy and PrEP deter many transgender and gender diverse people from taking PrEP, so it is crucial to educate people on how to safely use both.18

Lastly, PrEP provision should be conducted as a part of a more comprehensive sexual health program, including STI screening. For example, many people would benefit from incorporation of syphilis, chlamydia and gonorrhea with PrEP services.18

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Victoria’s last condomless receptive neovaginal sex was 5 days ago. This is beyond the 72-hour window for PEP. She does not report any signs and symptoms of acute HIV infection. What is the best management course?

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