• This recommendation is consistent with the 2019 USPSTF recommendation on PrEP for the prevention of HIV.
• For the current recommendation, the USPSTF reviewed additional evidence on new formulations of PrEP (tenofovir alafenamide/emtricitabine [TAF/FTC] and cabotegravir).

• Routinely take a sexual and injection drug use history for all patients.
• Inform all adolescents and adults who are sexually active or who inject drugs that there are ways to help prevent acquisition of HIV.

The USPSTF recommends that the following persons be considered for HIV PrEP:

1. Sexually active adults and adolescents weighing at least 35 kg (77 lb) who have engaged in anal or vaginal sex in the past 6 months and have any of the following: 
   • A sexual partner who has HIV (especially if the partner has an unknown or detectable viral load).
   • A bacterial sexually transmitted infection (syphilis, gonorrhea, or chlamydia for men who have sex with men and transgender women; gonorrhea and syphilis for heterosexual women and men) in the past 6 months.
   • A history of inconsistent or no condom use with sex partner(s) whose HIV status is not known; assessing risk in conversation with the patient and considering factors such as number of partners, the specific sexual activities a person engages in, and whether their sex partner or partners are in a group with a higher prevalence of HIV (eg, men who have sex with men or with men and women, transgender women, persons who inject drugs, and persons who engage in transactional sex).
2. Persons who inject drugs and have a drug injecting partner who has HIV or who shares injection equipment.

Transgender women are at especially high risk of HIV acquisition and should be considered for PrEP based on the criteria outlined above.
Persons who engage in transactional sex, such as sex for money, drugs, or housing, including commercial sex workers or persons trafficked for sex work, constitute a group at increased risk of HIV acquisition and should be considered for PrEP based on the criteria outlined above.
Persons who request PrEP may have undisclosed behaviors that put them at risk.

Effective formulations of PrEP with current US Food and Drug Administration approval include: 

• Oral tenofovir disoproxil fumarate/emtricitabine (TDF-FTC) and injectable cabotegravir are approved for use in at-risk adults and adolescents weighing at least 35 kg (77 lb) to reduce the risk of sexually acquired HIV.
• Oral TAF/FTC is approved for use in at-risk adults and adolescents weighing at least 35 kg (77 lb) to reduce the risk of sexually acquired HIV, excluding individuals at risk from receptive vaginal sex.
• No PrEP medications have FDA approval for the indication of reducing the risk of acquiring HIV via injection drug use, but Centers for Disease Control and Prevention (CDC) guidelines note that persons who inject drugs are likely to benefit from PrEP with any FDA-approved PrEP medication.
• It is important that persons taking PrEP receive counseling about medication adherence and safer sex including condom use, regular testing for HIV, and other necessary testing.

• The CDC provides guidelines on PrEP for the prevention of HIV infection (https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf and https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-provider-supplement-2021.pdf).
• The CDC provides additional resources on PrEP for both clinicians and consumers (https://www.cdc.gov/hiv/risk/prep/index.html).
• The CDC has compiled a list of PrEP interventions and best practices (www.cdc.gov/hiv/research/interventionresearch/compendium/prep/complete-list.html). County- and state-level HIV prevalence data for the US are available (https://www.cdc.gov/nchhstp/atlas).
• The USPSTF has developed a “Let’s Talk About It” guide for clinicians and patients about the use of HIV PrEP (https://uspreventiveservicestaskforce.org/uspstf/recommendation-topics/lets-talk-about-it-discussion-guides)