Pre-exposure prophylaxis (PrEP) is a highly effective medication for preventing HIV acquisition. Both starting and stopping PrEP require consultation with a healthcare provider to ensure the decision aligns with your current health and HIV risk profile. Understanding the factors for safe cessation is important for managing your sexual health.
Conditions for Discontinuation
Discontinuing PrEP is often considered when an individual’s risk for HIV exposure significantly changes. This includes entering a long-term, mutually monogamous relationship with an HIV-negative partner, where both are committed and not engaging in outside sexual activity.
Other reasons include sustained abstinence or a significant reduction in high-risk behaviors. For example, if sexual practices change to only oral sex or if injecting drugs ceases, daily PrEP may no longer be needed. Healthcare providers assess these changes by reviewing sexual history and lifestyle, ensuring discontinuation is appropriate.
The Discontinuation Process
Safely stopping PrEP begins with a healthcare provider consultation to assess current HIV risk and determine the best discontinuation method. HIV testing before stopping PrEP is important to confirm HIV-negative status and avoid drug resistance from an undiagnosed infection.
For daily oral PrEP, guidelines recommend continuing medication for a specific period after the last potential HIV exposure. For anal sex risk, continue PrEP for two days after the last sexual encounter. For vaginal sex or injection drug use risk, continue daily PrEP for 28 days after the last potential exposure. This ensures drug levels remain high enough to prevent infection. If you have chronic hepatitis B, discontinuing PrEP requires careful medical supervision, as stopping abruptly can cause a hepatitis B flare-up.
Post-Cessation Considerations
After discontinuing PrEP, protection against HIV is lost. Oral PrEP’s protective effects typically wane over 7 to 10 days, returning HIV acquisition risk to baseline if new exposures occur without other prevention. For injectable PrEP, HIV testing should continue for about 12 months after the last injection due to its long-acting nature.
Consider alternative HIV prevention strategies once PrEP is stopped, especially if risk factors change. Consistent condom use remains effective for preventing HIV and other STIs. Regular HIV testing is also important for early detection and treatment. Post-exposure prophylaxis (PEP) is an emergency measure for potential HIV exposure, ideally within 72 hours, but it is not a substitute for ongoing prevention.
Restarting PrEP is possible if circumstances change, such as relationship status or renewed higher-risk activities. Restarting also requires an HIV test to confirm negative status. Ongoing communication with a healthcare provider is important to reassess HIV risk and discuss suitable prevention options, ensuring continued safety.