PrEP to prevent HIV
PrEP is medicine taken before a possible exposure to lower the chance of getting HIV. The USPSTF recommends that clinicians prescribe it to teens and adults at increased risk of HIV (grade A, 2023). There is no age range: the recommendation uses a weight of at least 35 kg (77 lb). (USPSTF, 2023)
PrEP is not a treatment for HIV. Before starting, an HIV test rules out an infection, because the PrEP medicines used alone can lead to drug-resistant HIV in someone who already has it. (USPSTF, 2023) Ask your doctor or a sexual health clinic whether PrEP fits you.
- USPSTF grade
- A
- Who
- Teens and adults at increased risk of HIV
- Age
- No range; at least 35 kg (77 lb)
- Options
- Daily pills or an injection
Who the USPSTF says to consider for PrEP
| Situation | Consider PrEP if |
|---|---|
| Sexually active teens and adults (anal or vaginal sex in the past 6 months) | A partner has HIV; or a bacterial STI in the past 6 months; or inconsistent or no condom use with partners whose HIV status is unknown |
| People who inject drugs | An injecting partner has HIV, or they share injection equipment |
| Transgender women, and people who trade sex for money, drugs or housing | At especially high or increased risk; consider using the criteria above |
| Anyone who asks for PrEP | They may have risks they have not mentioned |
The USPSTF asks clinicians to tell all teens and adults who are sexually active or inject drugs that HIV can be prevented, so that PrEP can be discussed. Risk sits on a spectrum, and no risk tool is perfect. (USPSTF, 2023)
The PrEP options
| Option | Approved for |
|---|---|
| Oral TDF/FTC (pill) | Adults and teens at least 35 kg at risk from sex |
| Oral TAF/FTC (pill) | Adults and teens at least 35 kg at risk from sex, except risk from receptive vaginal sex |
| Injectable cabotegravir | Adults and teens at least 35 kg at risk from sex |
No PrEP medicine is FDA-approved for HIV risk from injecting drugs, but the USPSTF notes CDC guidance that people who inject drugs are likely to benefit from any approved PrEP medicine. (USPSTF, 2023)
PrEP comes with counseling on taking it as prescribed and on safer sex, including condoms, plus regular HIV tests. Tests for other STIs and for kidney function are done before starting. Your clinician chooses the option and the follow-up. (USPSTF, 2023)
What other groups say
As summarized by the USPSTF, the US Public Health Service recommends PrEP for sexually active adults and teens of at least 35 kg at substantial ongoing risk from sex or injecting drugs. The American College of Obstetricians and Gynecologists recommends discussing PrEP with all sexually active teens and adults and offering it to those at substantial risk. The main difference is how widely PrEP is discussed, not who it is offered to. (USPSTF, 2023)
Questions people ask
Who should take PrEP?
The USPSTF recommends PrEP for teens and adults at increased risk of HIV: for example, people whose sex partner has HIV, who had a bacterial STI in the past 6 months, who use condoms inconsistently with partners of unknown HIV status, or who share injection equipment. (USPSTF, 2023)
Is there an age limit for PrEP?
No age range is set. The USPSTF recommendation covers adolescents and adults who weigh at least 35 kg (77 lb). (USPSTF, 2023)
Is PrEP a pill or a shot?
Both exist. The USPSTF lists two daily pills (TDF/FTC and TAF/FTC) and an injection (cabotegravir) with FDA approval for PrEP. TAF/FTC is not approved for risk from receptive vaginal sex. (USPSTF, 2023)
Do I need HIV tests while on PrEP?
Yes. An HIV test comes before starting, and regular HIV testing is part of taking PrEP, along with other tests your clinician orders. (USPSTF, 2023)
This page explains what the guidelines say. It cannot tell you what is right for you: talk to your doctor.