Clinicians should regularly advise people using PrEP about how to discontinue PrEP. The need for PrEP may end when a partner with HIV achieves sustained HIV viral suppression after at least 6 months of antiretroviral therapy, when a patient enters a mutually monogamous relationship with a seroconcordant partner, or when other social circumstances change.
Discontinuing daily PrEP in MSM
There is now substantial clinical evidence that cis-gender MSM can safely cease daily PrEP by taking a dose of PrEP 24 and 48 hours after their last at-risk sexual exposure (9-11). Recently WHO recommended that MSM who take either daily or on-demand† PrEP can safely cease PrEP by taking a dose of PrEP 24 and 48 hours after the first two pills if taking event based or if taking daily PrEP they can cease PrEP by taking a single daily pill for each of two days after the last sex act (6). The ASHM PrEP Guidelines Panel agrees with this recommendation.
Discontinuing daily PrEP for other populations
One US study recommends that PrEP should be continued for 28 days after the last at-risk sexual exposure (31). The ASHM PrEP Guidelines Panel recommends that clinicians should offer this advice for all people other than cis-gender MSM using daily PrEP until more information is available.
Discontinuing on-demand† PrEP
On-demand† PrEP can be ceased by taking a single daily PrEP tablet for 2 days after the last sex act, as described above.
Upon discontinuation for any reason, the following should be documented in the health record:
- HIV status at the time of discontinuation
- Reasons for PrEP discontinuation
- Recent medication adherence and reported sexual risk behaviour.
† The Therapeutic Goods Administration (TGA) has not approved this regimen in Australia.