Clinical assessment before starting PrEP
Patients being suitable for PrEP can also be at risk of acquiring hepatitis A, hepatitis B virus (HBV) infection (25) and hepatitis C virus (HCV) [infection (26). Hepatitis A, HBV and HCV infection status should be documented by screening serology when PrEP is initiated.
Vaccination against hepatitis A and HBV is recommended for all susceptible priority populations, which include MSM, sex workers, people from countries with a high HIV, HBV or HCV prevalence, and their sexual partners and people who inject drugs (27, 28). Individuals identified at baseline as having undiagnosed chronic hepatitis B should be referred to a clinician experienced in the management of hepatitis B for treatment assessment. Individuals with chronic hepatitis B infection should only be offered daily PrEP and not on-demand† PrEP. They should also be counselled on the importance of strict adherence to PrEP to prevent both a flare in their hepatitis B infection and the development of hepatitis B resistance to TD*/FTC. Individuals identified at baseline with undiagnosed hepatitis C infection should be referred to a clinician experienced in hepatitis C management for consideration of hepatitis C treatment. A diagnosis of hepatitis B or hepatitis C is not an obstacle to HIV PrEP initiation.
† The Therapeutic Goods Administration (TGA) has not approved this regimen in Australia.