Condition
Pre-exposure prophylaxis (PrEP) medications are drugs that are highly effective in preventing HIV infection in people who may be exposed to HIV in the future.
Currently approved formulations include oral emtricitabine plus tenofovir (Truvada or Descovy) taken daily, and long-acting injectable cabotegravir (Apretude) taken every 2 months.
Post-exposure prophylaxis (PEP) is the use of HIV prevention medications after an exposure to HIV. This could be an unexpected exposure at work for health care and emergency caregivers or an unexpected exposure through sexual contact.
Guidance at RECRUITMENT
ACCEPTABLE
Guidance at CT/WORK-UP
A donor using PrEP/ PEP may be acceptable at the discretion of the requesting transplant center. The transplant center should be told that the donor is using PreP/ PEP, and if so, whether donor is on a long-acting injectable formulation or is using the oral formulation daily or on-demand (i.e. before/ after sexual encounters, see Molina et al., N Eng J Med 2015).
Individual at Risk
Recipient (due to interference with HIV testing)
Justification for guidance
Since peoples’ sexual practices change over time, and since the window period for HIV detection is less than three months, a sexual history is not necessary at the time of recruitment and need only be taken from potential donors at the time of confirmatory typing and workup assessment. Furthermore, individuals should not be deferred at time of recruitment due to behavioral risk factors for infectious disease.
PrEP/ PEP medications are highly effective at preventing HIV transmission when used as prescribed. However, the medications are not 100% effective, and it is possible for an individual to become infected with HIV while taking them. If PrEP/ PEP is not used as prescribed, there is a greater chance for becoming infected with HIV. This is called a “breakthrough” HIV infection. Additionally, PrEP/ PEP interfere with accurate HIV testing: if an individual is HIV-positive, these medications may cause the HIV viral load in the blood to temporarily drop to a level that cannot be detected but could still be transmitted to a patient.
For individuals who were previously on PrEP/ PEP, the following washout periods are required before accurate HIV testing can be performed:
Oral PrEP (e.g. Truvada, Descovy) or PEP: deferral for 3 months after the last dose.
Injectable PrEP (e.g. Apretude): deferral for 2 years after the last injection.
Importantly, donors must not be pressured to stop PrEP or PEP for these washout periods to permit donation, as this could increase their risk of contracting HIV.