What PIP is: Providing a HIV post-exposure prophylaxis (PEP) prescription (28-days) for HIV-negative people who have 0-4 high risk HIV exposures per year. Patients are seen every 4-6 months for HIV/STI screening and to re-evaluate exposures and discuss which HIV prevention method currently works best for them (PIP, PrEP, condoms).
Evidence: Updated data for this PIP study presented at IDweek in October 2023 showed that of the 69 courses of PIP initiated, there were 0 (zero) HIV seroconversions. PIP is 43% less costly than PrEP.
PIP regimens used: Biktarvy and TDF/F+DTG (Truvada with Tivicay). 2024 CROI update: a prospective study using Biktarvy as PEP in 119 people found high tolerability, high adherence, and no seroconversions, which matches previously published data on Biktarvy for PEP.
Difference between PIP and doxy-PEP: Doxy-PEP is for STI prevention whereas PIP is for HIV prevention. Both are post-exposure prophylaxis on-hand (prescribed before exposures) and should be taken within 72 hours after exposures.
Difference between PIP, PrEP 2-1-1 and daily/injectable PrEP:
PIP is intended for people with fewer HIV exposures (0-4 per year).
PrEP 2-1-1 can also be for people with fewer HIV exposures but needs to be started 2- 24 hours before exposures and is only proven for condomless anal sex among MSM.
Daily/injectablePrEP is for people with more frequent HIV exposures and can take daily medications or come in every 2 months for injections.
Patients can toggle between PIP, 2-1-1 PrEP and daily/injectable PrEP depending on their current exposure risks and medication preferences.
For patients on PrEP, consider prescribing PIP as a backup self-initiated prevention method.
How to offer PIP: please see the graphic below for the recommended process from the PIP study authors. For more details, download their PIP Provider Toolkit.
