PrEP suitability criteria for heterosexuals

Box 4.3 PrEP suitability criteria for heterosexuals

HIV risk in the previous 3 months and the future 3 months

The clinician should prescribe PrEP if the patient describes a history of any of the following HIV acquisition risks in the previous 3 months and if the patient foresees that there are likely to be similar acquisition risks in the next 3 months:

At least one episode of condomless anal or vaginal intercourse (insertive or receptive) with a regular HIV-positive partner who is either not on treatment, or who is on treatment but has a detectable HIV viral load
At least one episode of receptive anal or vaginal condomless intercourse with any casual HIV-positive partner or a male homosexual or bisexual partner of unknown status
Episodes of planned condomless insertive or receptive vaginal sex in an effort to conceive with an HIV-positive partner, regardless of the HIV-positive partner’s viral load

HIV risk in the future 3 months

The clinician should prescribe PrEP if the patient foresees that they will have HIV acquisition risk in the upcoming 3 months, despite not having had HIV acquisition risk in the previous 3 months:

Future episodes of planned condomless insertive or receptive vaginal sex in an effort to conceive with an HIV-positive partner, regardless of the HIV-positive partner’s viral load
When a person plans to travel to countries with high HIV prevalence during which time they anticipate having condomless sex with casual partners who are HIV positive or of unknown HIV serostatus
When a person plans to return home to an overseas country which has a high HIV prevalence during which time they anticipate that they will be having condomless sex with casual partners
When a person reports that they have recently left a monogamous relationship and will be having condomless sex with a casual HIV-positive partner, or a male or female partner of unknown HIV serostatus from a country with high HIV prevalence, or a male partner who is thought to have sex with men
When a person presents with concerns of deteriorating mental health and a history of having had increased their HIV acquisition risk behaviour in this setting
When a person presents with a history of intermittent binge drinking of alcohol or recreational drug use and a history of having had increased their HIV acquisition risk behaviour in this setting.

The clinician should consider prescribing PrEP also in the following circumstances:

When an HIV serodiscordant couple experience undue suffering and anxiety about inter-couple HIV transmission despite the positive partner being virologically suppressed on treatment.