Click below to download the full *updated* Dear Colleague Letter.
We’re writing to share with you recommendations on how to incorporate new developments in HIV prevention and care into your practice.
The San Francisco Department of Public Health recommends that you:
Updated CDC recommendations on which HIV tests to use when prescribing daily PrEP, and how often to screen for bacterial STIs: CDC now recommends antigen/antibody testing over antibody-only testing; they also provide guidance on interpretation of HIV RNA testing used for PrEP. See details below. Furthermore, CDC now recommends that MSM “at high risk for recurrent STIs” undergo screening every three months.
There is a non-daily dosing strategy for PrEP that was studied in MSM in France and Canada, and is being used in some clinics in Europe and Canada. This non-daily strategy, also known as “Intermittent”, “Event-Driven,” “Sex-Driven,” “On Demand,” or “2-1-1” PrEP, may be appropriate for some MSM. SFDPH has released guidance on this dosing strategy (see below) for MSM who do not want to use daily emtricitabine/tenofovir disoproxil fumarate (also known as FTC/TDF or Truvada®), which is currently the only FDA-approved dosing strategy for PrEP in the United States.
Recent data suggest a possible association between use of the antiretroviral drug dolutegravir by women around the time of conception, and subsequent neural tube defects in their infants. The U.S. Public Health Service has issued recommendations regarding the use of dolutegravir (Tivicay®) for ongoing antiretroviral therapy (ART) or post-exposure prophylaxis (PEP) by women of childbearing potential (this also applies to co-formulations of dolutegravir such as dolutegravir/abacavir/lamivudine, or Triumeq®, and dolutegravir/rilpivirine, or Juluca®). More details, as well as links to USPHS recommendations can be found below.