Lesson
Build the Full HIV Prevention Continuum
Prevention is not one medicine. Sustained viral suppression, PrEP, PEP, testing, STI care, vaccination, harm reduction, and reproductive care solve different parts of the same problem.
- U equals U
- PrEP
- PEP
- STI prevention
- Harm reduction
Carry this evidence forward.
Carry this evidence forward.
Carry this evidence forward.
Own the next clinical action.
Start with treatment as prevention
A person with HIV who maintains an undetectable viral load does not sexually transmit HIV. U equals U depends on sustained suppression and does not mean HIV has been cured.
Offer PrEP without gatekeeping
Current CDC guidance recommends informing sexually active adults and adolescents about PrEP and prescribing it to anyone who asks, even when no formal risk factor is disclosed.
Keep prevention comprehensive
PrEP does not prevent other STIs or pregnancy. Pair it with exposure-site STI screening, condoms when desired, contraception, vaccination, sterile injection equipment, and substance-use care.
Use PEP for an emergency
PEP is a time-limited response after a substantial exposure. It should lead into PrEP when future exposure is expected, not function as a recurring substitute for planned prevention.
Quick check
Lesson
Exclude Acute HIV Before Prevention
PrEP is incomplete HIV treatment. Starting or continuing it during undiagnosed infection can select resistance, especially during a long-acting drug tail.
- Ag or Ab
- HIV-1 RNA
- Acute HIV
- Discordant tests
- ARV exposure
Carry this evidence forward.
Carry this evidence forward.
Carry this evidence forward.
Own the next clinical action.
Ask about the diagnostic window
Review recent exposures, fever, rash, lymphadenopathy, pharyngitis, diarrhea, myalgia, and prior PrEP or PEP. A negative antibody-only test does not exclude very early infection.
Use blood-based testing
Obtain a laboratory HIV Ag or Ab test and use HIV-1 RNA when acute infection is suspected or recent antiretroviral exposure can alter detection. Oral-fluid rapid tests are less sensitive for recent infection.
Respect long-acting diagnostic shadow
Cabotegravir and lenacapavir can suppress early viral replication and delay seroconversion. Test before every long-acting dose and investigate discordant or ambiguous results before proceeding.
Convert failure into complete care
When HIV is diagnosed, stop treating the person as a prevention patient. Obtain resistance data informed by every prevention exposure and construct a complete suppressive ART regimen.
Quick check
Lesson
Use F/TDF Across Its Broad Prevention Role
Daily emtricitabine and tenofovir disoproxil fumarate is approved for sexual and injection-related exposure prevention. Its breadth comes with renal, bone, HBV, and adherence responsibilities.
- F/TDF
- Daily oral
- eCrCl
- HBV
- Tissue timing
Carry this evidence forward.
Carry this evidence forward.
Carry this evidence forward.
Own the next clinical action.
Know who can use it
F/TDF is an option for adults and adolescents weighing at least 35 kg across sexual exposure routes and injection drug use. It is the oral option with the broadest approved population.
Calculate renal eligibility
Use Cockcroft-Gault estimated creatinine clearance. F/TDF PrEP requires eCrCl of at least 60 mL/min and closer monitoring when age or renal risk increases.
Counsel tissue timing
Maximum drug levels associated with protection occur after about 7 days of daily use for receptive anal sex and up to about 21 days for receptive vaginal sex or injection exposure.
Use pregnancy evidence
F/TDF is generally considered safe during pregnancy and breast or chestfeeding. Use shared decision-making because pregnancy itself can increase HIV acquisition risk.
Quick check
Lesson
Keep F/TAF Inside Its Evidence Boundary
Daily emtricitabine and tenofovir alafenamide offers a lower renal threshold and different bone and metabolic tradeoffs, but it is not approved for receptive vaginal exposure.
- F/TAF
- Receptive vaginal sex
- eCrCl
- Lipids
- Weight
Carry this evidence forward.
Carry this evidence forward.
Carry this evidence forward.
Own the next clinical action.
Respect the route boundary
F/TAF is approved for sexual HIV prevention except in people whose relevant exposure is receptive vaginal sex, where efficacy has not been established.
Use the renal threshold
F/TAF can be used when Cockcroft-Gault eCrCl is at least 30 mL/min. Kidney and nephrotoxin review still matters.
Compare organ tradeoffs
TAF generally produces less renal tubular and bone mineral exposure than TDF, while lipid and weight changes may favor TDF. There is no universally safer nucleotide formulation.
Monitor metabolism
Obtain cholesterol and triglycerides before F/TAF PrEP and monitor lipids and weight during use according to current guidance.
Quick check
Lesson
Run Cabotegravir as a Long-Acting Prevention System
Apretude avoids daily oral adherence and tenofovir kidney constraints. In exchange, it requires precise HIV testing, gluteal injection delivery, target-date tracking, and tail protection.
- Apretude
- Gluteal IM
- Every 2 months
- Optional lead-in
- Pharmacologic tail
Carry this evidence forward.
Carry this evidence forward.
Carry this evidence forward.
Own the next clinical action.
Initiate correctly
Give 600 mg intramuscularly, repeat 1 month later, then continue every 2 months. A 4-week oral cabotegravir lead-in is optional.
Test at every cycle
Confirm HIV-negative status with the recommended Ag or Ab and RNA strategy before initiation and each injection. Do not inject through unresolved acute symptoms or discordant results.
Manage common reactions
Injection-site pain, tenderness, swelling, induration, nodules, bruising, warmth, and erythema are common and usually mild or moderate. Technique and expectation-setting support persistence.
Protect the tail
Residual cabotegravir can remain for 12 months or longer. When injections stop and exposure continues, begin alternative PrEP within 2 months and continue HIV testing after the final dose.
Quick check
Lesson
Add Twice-Yearly Lenacapavir Without Losing Precision
Yeztugo is a capsid inhibitor approved in 2025 for sexually acquired HIV prevention. Its 26-week interval is powerful only when loading, interactions, testing, delayed-dose management, and the prolonged tail are exact.
- Yeztugo
- Capsid inhibitor
- Subcutaneous
- 26 weeks
- Drug tail
Carry this evidence forward.
Carry this evidence forward.
Carry this evidence forward.
Own the next clinical action.
Place the mechanism
Lenacapavir disrupts multiple capsid-dependent steps, including nuclear transport, assembly, and capsid formation. It is neither an NRTI nor an INSTI.
Complete the loading sequence
On day 1, administer 927 mg subcutaneously as two injections and give 600 mg orally. Give another 600 mg orally on day 2.
Continue every 26 weeks
Administer 927 mg subcutaneously as two injections every 26 weeks with a plus or minus 2-week window. Labeled weekly oral bridging can cover an anticipated delay, while a longer unbridged delay can require re-initiation.
Manage resistance and interactions
Confirm HIV-negative status before every dose. Review CYP3A, P-gp, and UGT1A1 inducers and sensitive substrates. Residual concentrations can persist for 12 months or longer after stopping.
Quick check
Lesson
Protect Kidney, Bone, Liver, and Continuity
Oral PrEP requires more than a creatinine value. The pharmacist must compare renal and bone exposure, metabolic effects, HBV activity, nephrotoxins, and the consequences of stopping.
- Cockcroft-Gault
- Bone
- Lipids
- HBV
- Discontinuation
Carry this evidence forward.
Carry this evidence forward.
Carry this evidence forward.
Own the next clinical action.
Screen for HBV
F/TDF and F/TAF both suppress HBV. Active HBV is not a contraindication, but stopping can cause HBV rebound and severe hepatic flare. Establish HBV status, vaccination needs, and a discontinuation plan.
Individualize renal follow-up
Monitor eCrCl at least every 6 months for patients age 50 or older or with baseline eCrCl below 90, and at least annually for everyone continuing oral PrEP. Add testing for diabetes, hypertension, nephrotoxins, or concerning trends.
Compare TDF and TAF
TDF can reduce bone mineral density and has more renal tubular exposure. TAF can raise lipids and weight relative to TDF. Choose from the patient's dominant risks and exposure route.
Represent 2-1-1 accurately
Off-label 2-1-1 F/TDF has evidence only in adult gay and bisexual men who can anticipate infrequent sex. CDC does not recommend it, and it is inappropriate for active HBV or receptive vaginal exposure.
Quick check
Lesson
Make Every PrEP Visit a Prevention Decision
Follow-up verifies that HIV is still excluded, the selected modality is reaching the person, safety remains acceptable, and the wider prevention plan still fits.
- HIV testing
- Adherence
- Target dates
- STI screening
- Modality switching
Carry this evidence forward.
Carry this evidence forward.
Carry this evidence forward.
Own the next clinical action.
Test by modality
Use current CDC agent-specific testing intervals and include HIV-1 RNA with laboratory Ag or Ab testing for oral and long-acting PrEP care. Never refill or inject through unresolved infection evidence.
Verify real delivery
Ask about oral doses without judgment, confirm pharmacy access, track every injection target date, and use consented outreach before long-acting doses become late.
Screen by exposure
Perform bacterial STI screening at relevant anatomic sites and intervals. Revisit pregnancy, contraception, injection equipment, substance-use care, vaccination, and symptoms.
Switch without gaps
Plan modality transitions around the onset and offset of protection, the prior product's tail, HIV testing, and access. Convenience switches should not create an unprotected interval.
Quick check
Lesson
Triage the Route, Fluid, Source, and Clock
PEP decisions require a plausible portal of entry, a potentially infectious fluid, source evidence, and time since exposure. Urgency does not eliminate careful classification.
- Percutaneous
- Mucous membrane
- Nonintact skin
- Source suppression
- 72 hours
Carry this evidence forward.
Carry this evidence forward.
Carry this evidence forward.
Own the next clinical action.
Define the portal
Percutaneous injury, mucous-membrane contact, nonintact-skin contact, and selected sexual exposures can provide entry. Intact skin does not.
Define the fluid
Blood, visibly bloody fluid, semen, vaginal or rectal secretions, and selected sterile-site fluids can carry HIV. Nonbloody saliva, sweat, tears, urine, and feces do not ordinarily indicate PEP.
Use source evidence
Determine source HIV status and sustained viral suppression when possible. Do not delay the first dose while results are pending, and stop PEP if the source is confirmed not to have HIV.
Respect the clock
Start as soon as possible, ideally within 24 hours and no later than 72 hours. Beyond 72 hours, provide testing, prevention planning, and expert consultation rather than routine PEP.
Quick check
Lesson
Use Current Nonoccupational PEP
The 2025 CDC nPEP guideline replaces the older RxPrep regimen and 6-month follow-up frame with second-generation INSTI options, urgent complete access, and modern Ag or Ab plus RNA testing.
- nPEP
- BIC/FTC/TAF
- Dolutegravir
- 28 days
- Follow-up testing
Carry this evidence forward.
Carry this evidence forward.
Carry this evidence forward.
Own the next clinical action.
Select a preferred regimen
For most adults and adolescents, use BIC/FTC/TAF or dolutegravir plus TAF or TDF plus FTC or lamivudine. Individualize for organs, pregnancy, interactions, prior ARVs, source resistance, and access.
Secure all 28 days
The recommended course is 28 days. If a starter pack is used, guarantee the remaining supply before the starter doses run out.
Run baseline care in parallel
Obtain HIV testing, creatinine, AST, ALT, HBV, and pregnancy testing when relevant. Add HCV, STI, emergency contraception, vaccination, and trauma-informed assault care according to the exposure.
Use modern follow-up
Contact the person within 24 hours. Perform Ag or Ab plus diagnostic NAT testing at 4 to 6 weeks when indicated and final testing at 12 weeks after exposure. Build a PrEP transition for ongoing exposure.
Quick check
Lesson
Modernize Occupational Exposure Care
The 2025 U.S. Public Health Service guideline updates healthcare-personnel PEP regimens and follow-up while preserving immediate first aid, reporting, source evaluation, and expert consultation.
- Occupational exposure
- First aid
- Source testing
- Three-drug PEP
- Employee health
Carry this evidence forward.
Carry this evidence forward.
Carry this evidence forward.
Own the next clinical action.
Respond immediately
Wash needlesticks and cuts with soap and water and flush mucous membranes with water. Report through the occupational pathway without delay.
Characterize exposure and source
Document device, depth, visible blood, fluid, portal, source HIV testing, and sustained suppression. Obtain source testing with appropriate consent and do not test discarded needles.
Use current preferred therapy
Preferred 28-day regimens include BIC/FTC/TAF or dolutegravir plus TAF or TDF plus FTC or lamivudine. Seek expert input for pregnancy, organ dysfunction, interactions, or resistance.
Focus follow-up
Current guidance shortens HIV follow-up and does not require routine toxicity laboratories for every healthy worker on modern PEP. Tailor tests to the regimen, symptoms, comorbidities, and source evidence.
Quick check
Lesson
Close the PEP-to-PrEP Handoff
An emergency course is not complete until ongoing exposure, future prevention, final testing, medication continuity, and ownership of every result are addressed.
- Day 28
- Immediate transition
- PrEP choice
- Resistance
- Closed loop
Carry this evidence forward.
Carry this evidence forward.
Carry this evidence forward.
Own the next clinical action.
Plan at initiation
Ask whether future exposure is anticipated and discuss oral, cabotegravir, and lenacapavir PrEP options while the 28-day course is underway.
Transition without a gap
After appropriate HIV testing at PEP completion, a person with ongoing exposure can move directly into a recommended PrEP regimen. An unprotected waiting period is not required.
Keep final testing
Starting PrEP does not cancel the final 12-week postexposure test. Explain how ongoing ARV exposure can affect diagnosis and why Ag or Ab plus RNA testing matters.
Escalate possible acquisition
Symptoms, viral RNA, seroconversion, or discordant testing during prevention require urgent resistance-aware HIV treatment evaluation. Do not continue prevention-only therapy as incomplete ART.
Quick check
Module test
Check the connections.
Each attempt draws 10 questions from the complete 168 question bank.
Each attempt draws a fresh set and rearranges the answer choices.
References
Current clinical foundation.
Lecture material was synthesized with the following contemporary guidance. Verify local policy and current guidance before applying clinical information.
- CDC Clinical Guidance for PrEP
- CDC 2025 Lenacapavir PrEP Recommendation
- CDC 2025 Nonoccupational PEP Guideline
- U.S. Public Health Service 2025 Occupational PEP Guideline
- FDA Yeztugo Prescribing Information
- FDA Apretude Prescribing Information
- FDA Truvada Prescribing Information
- FDA Descovy Prescribing Information