Canadian guidelines on HIV pre- and postexposure prophylaxis: 2025 update
CTN+
This guideline updates the 2017 guideline on clinical indications and drug regimens for PrEP and PEP in Canada and contains 31 recommendations and 10 good practice statements.
Learning Activity
Please note: Due to an ongoing cyber attack targeting the learning management platform Canvas, this course is temporarily unavailable. The course is currently being moved to an alternative platform. Please check back soon for updates on this process.
Co-developed by CTN+ and CATIE, this asynchronous e-learning course offers an overview of the HIV pre-exposure prophylaxis (PrEP) and HIV post-exposure prophylaxis (PEP) guidelines over 4 modules. This course is designed for healthcare professionals who want to prescribe PrEP and PEP to their patients. Throughout this course, participants will learn an overview of HIV in Canada, when PrEP and PEP should be prescribed, the different regimens that exist including details on prescribing injectable cabotegravir for HIV PrEP, and other considerations for counseling and prescribing PrEP and PEP.
Learners will receive a certificate upon completion of all learning activities from the College of Family Physicians of Canada, the Canadian Council on Continuing Education in Pharmacy, or the Royal College of Physicians and Surgeons of Canada.
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Led by Prevention & Testing Think Tank Co-lead Dr. Darrell Tan, this guideline updates the 2017 guideline on clinical indications and drug regimens for PrEP and PEP in Canada and contains 31 recommendations and 10 good practice statements.
AccessBackground
New HIV infections occur annually in Canada, highlighting the need for pre- and postexposure prophylaxis (PrEP and PEP). Through the Canadian Institutes of Health Research (CIHR) Pan-Canadian Network for HIV/AIDS and STBBI (sexually transmitted and blood-borne infections) Clinical Trials Research, we have updated the 2017 guideline on clinical indications and drug regimens for PrEP and PEP in Canada.
Methods
Drawing on meetings with community-based organizations representing key populations affected by HIV in Canada, along with evidence from 3 systematic reviews on PrEP, PEP, and HIV risk assessment tools (searches to June 2024), our diverse panel of 19 experts formulated recommendations on PrEP and PEP. We used a formal evidence-to-decision-making framework and the Grading of Recommendations, Assessment, Development, and Evaluation system. We followed the Guidelines International Network principles for managing competing interests. Our guideline development and reporting adhere with Appraisal of Guidelines for Research and Evaluation II.
Recommendations
This guideline contains 31 recommendations and 10 good practice statements. Although it is appropriate to prescribe PrEP to adults and adolescents who request it, clinicians are also encouraged to assess HIV risk during routine health visits to identify people who would benefit from PrEP. Clinicians should elicit information about patients’ anatomy and sexual partners in a culturally sensitive and affirming manner to determine which PrEP regimens — daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC), on-demand TDF/FTC, daily oral tenofovir alafenamide/emtricitabine, or long-acting injectable cabotegravir — are suitable options. When assessing whether PEP is needed, clinicians should consider the likelihood that the source person has transmissible HIV, as well as the biological risk of HIV transmission based on exposure type. Preferred PEP regimens are dolutegravir plus TDF/FTC, or bictegravir/tenofovir alafenamide/emtricitabine.
Interpretation
Multiple safe, effective PrEP and PEP regimens are now available in Canada, making it increasingly possible to find suitable options for all who could benefit. Implementation of this guideline should expand access to biomedical HIV prevention interventions for those at risk and decrease the incidence of HIV in Canada.