Pre-exposure prophylaxis for HIV prevention, commonly known as PrEP (pronounced as prep, ), is the use of antiviral drugs as a strategy for the prevention of HIV/AIDS by people that do not have HIV/AIDS. PrEP is one of a number of HIV prevention strategies for people who are HIV-negative but who have a higher risk of acquiring HIV, including sexually active adults who are at increased risk of contracting HIV, people who engage in intravenous drug use (see drug injection), and serodiscordant sexually active couples. The first form of PrEP for HIV prevention—emtricitabine and tenofovir disoproxil (FTC/TDF; Truvada)—was approved in 2012. In October 2019, the US Food and Drug Administration (FDA) approved the combination of emtricitabine and tenofovir alafenamide (FTC/TAF; Descovy) to be used as PrEP in addition to Truvada, which provides similar levels of protection. Descovy, however, is currently approved only for cisgender men and transgender women as the efficacy has not been assessed in people at risk for HIV through receptive vaginal sex. In December 2021, the US FDA approved cabotegravir (Apretude), which is an injectable form of PrEP manufactured by Viiv Healthcare. Regulators believe it will improve medication adherence because it has to be taken just once every two months, and it will also widen adoption as it eliminates the need to hide pills or pharmacy visits for discretion. In its 2021 guidelines, the World Health Organization (WHO) recommends several options for PrEP, tailored to different populations and circumstances:
Oral PrEP using TDF-containing compounds for anyone at substantial risk of HIV infection; Event-driven PrEP for men who have sex with men (MSM); and The dapivirine vaginal ring (DPV-VR) for women at substantial risk of HIV infection who do not have access to oral PrEP. On 18 June 2025, the FDA approved the long-acting HIV prevention antiretroviral lenacapavir in the United States. The drug is branded as Yeztugo by Gilead Sciences and requires only two subcutaneous injections per year, demonstrating high efficacy in clinical trials by offering nearly complete protection against HIV infection. As the second PrEP extended-release option following cabotegravir, lenacapavir's simplified dosing schedule could significantly improve patient access and adherence, especially for populations at higher risk of HIV. However, the global rollout may be challenged by recent funding reductions by the Trump Administration in global health funding by the United States that were expected to support lenacapavir access in lower-income countries across sub-Saharan Africa by PEPFAR. In September 2025, global partnerships set lenacapavir's HIV prevention price at US$40 per patient annually in 120 low- and middle-income countries. The WHO is planning to adopt lenacapavir in global guidelines for resource-limited settings as well as for WHO pre-qualification regulatory approval.
Medical uses
Indications for use
United States In the United States, federal guidelines updated in 2021 now recommend healthcare providers discuss and provide information on the use of PrEP for HIV prevention for all sexually active adults and adolescents. The US Centers for Disease Control and Prevention (CDC) recommends providers take a targeted sexual history of their patients to assess specific risk for HIV acquisition and suggest PrEP to the following patients:
Sexually active adults and adolescents who have had anal or vaginal sex in the past six months and any of the following: One or more partner(s) with unknown HIV status and inconsistent condom use; An HIV-positive sexual partner (especially if they have an unknown or detectable viral load); A bacterial sexually transmitted infection (STI) in the past six months. Patients reporting injection drug use within the last six months and any of the following: An HIV-positive injecting partner; Shared injection equipment. Additionally, these updated guidelines recommend providers prescribe PrEP to any patient that requests it, regardless of their stated risk factors.
United Kingdom In the United Kingdom the BHIVA/BASHH guidelines on the use of HIV pre-exposure prophylaxis (PrEP) 2018 recommend:
On-demand or daily oral tenofovir–emtricitabine (TD-FTC) for HIV-negative MSM who are at elevated risk of HIV acquisition through unprotected anal sex in the previous six months and ongoing unprotected anal sex. On-demand or daily oral TD-FTC for HIV-negative MSM having unprotected anal sex with partners who are HIV-positive, unless the partner has been on AntiRetroviral Therapy (ART) for at least six months and their plasma viral load is <200 copies/mL. Tenofovir (TDF) alone should not be offered to MSM. Daily oral TD-FTC for HIV-negative heterosexual men and women having unprotected sex with partners who are HIV-positive, unless the partner has been on ART for at least six months and their plasma viral load is <200 copies/mL. Daily oral TD-FTC for heterosexual men and women on a case-by-case basis with current factors that may put them at increased risk of HIV acquisition. TDF alone can be offered to heterosexual men and women where FTC is contraindicated. PrEP is not recommended for people who inject drugs where needle exchange and opiate substitution programs are available and accessed by the individual. PrEP with daily oral TD-FTC for HIV-negative trans women who are at risk of HIV acquisition through unprotected anal sex in the previous six months and ongoing unprotected sex. Daily oral TD-FTC for HIV-negative trans women and trans men who have unprotected sex with partners who are HIV-positive, unless the partner has been on ART for at least six months and their plasma viral load is <200 copies/mL.
Other countries Other government health agencies from around the world have devised their own national guidelines for how to use PrEP to prevent HIV infection in those at high risk, including Botswana, Kenya, Lesotho, South Africa, Uganda, the Zambia, and Zimbabwe.
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