HIV testing prior to initiating PrEP

This algorithm discusses the approach to HIV testing in persons who plan to initiate PrEP. Testing should be performed within one week of initiating therapy. The choice of agent (tenofovir disoproxil fumarate-emtricitabine, tenofovir alafenamide-emtricitabine, long-acting cabotegravir) depends upon availability, patient preference, and the presence of certain comorbid conditions. Refer to UpToDate content on pre-exposure prophylaxis for a discussion of regimen selection as well as the approach to HIV testing for monitoring people receiving PrEP. Patients who test positive for HIV should be referred for appropriate HIV care as soon as possible so they can be started on an effective antiretroviral therapy regimen.

PrEP: pre-exposure prophylaxis; PEP: post-exposure prophylaxis; Ag: antigen; Ab: antibody.

* Signs and symptoms of acute HIV may include fevers, chills, rash, and/or pharyngitis. Refer to topics on Acute HIV for additional information.

¶ Additional testing with HIV RNA is warranted in persons who have recently received PrEP or PEP since the sensitivity of the antigen/antibody test may be reduced.

Δ If antigen/antibody test is positive or HIV RNA is detected at any level, PrEP should not be initiated. Such patients should be managed in consultation with a specialist in HIV care.

◊ If a rapid antigen/antibody test was performed, a laboratory-based test should be sent as well. However, PrEP does not need to be delayed pending the result of the laboratory-based test.

§ An HIV RNA test should be performed in addition to an antigen/antibody test to minimize the risk of unrecognized HIV infection, which may result in cabotegravir resistance and limit HIV treatment options.

¥ In persons with a low HIV RNA, a false positive result is possible.

Preexposure Prophylaxis for the Prevention of HIV Infection in the United States (2021 Update) – Clinical Practice Guideline. United States Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf. (Accessed on August 26, 2022).

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HIV testing prior to initiating PrEP