PrEP (HIV Pre-Exposure Prophylaxis)#

PrEP is an antiretroviral medication - the same class of drug used to treat HIV - taken before potential exposure to keep HIV from establishing infection if you are exposed. It works by maintaining drug levels in your body that prevent the virus from replicating after it enters cells.

Used as prescribed, PrEP is one of the most effective HIV-prevention tools available and is supported by Canadian and international guidelines.

• Daily oral PrEP: reduces the risk of HIV from sex by ~99% and from injection drug use by at least 74% when taken consistently.
• On-demand (2-1-1) oral PrEP: about 86-97% effective for receptive anal sex among MSM when taken correctly.
• Injectable PrEP: highly effective, and more effective than daily oral PrEP in major clinical trials, especially for patients who have trouble taking pills consistently.

Effectiveness drops sharply if PrEP is not taken consistently. Adherence to the schedule is the single biggest factor in how well it works.

Reference: CATIE - Pre-Exposure Prophylaxis (PrEP)

PrEP and PEP both prevent HIV but in different situations:

• PrEP is taken before potential exposure, on an ongoing basis, by people with continued risk.
• PEP (Post-Exposure Prophylaxis) is taken after a possible HIV exposure (condom break, needle share, sexual assault, etc.) and must be started within 72 hours of exposure. It's a 28-day course and is an emergency treatment - not for ongoing prevention.

If you've needed PEP more than once, that's usually a signal that PrEP would be a better long-term fit.

For a current high-risk exposure: PEP isn't something we can prescribe through virtual care - go to an emergency department right away. After completing PEP and confirming you remain HIV-negative, you can start PrEP through TeleTest if ongoing prevention makes sense.

PrEP works best combined with other prevention strategies:

• Condoms - prevent HIV plus other STIs (chlamydia, gonorrhea, syphilis, HSV) that PrEP doesn't cover.
• Regular HIV and STI testing - to know your status and catch any breakthrough infection early.
• U=U (Undetectable = Untransmittable) - if your partner is HIV-positive and on effective treatment with an undetectable viral load, they cannot transmit HIV sexually.
• Doxy-PEP - for bacterial-STI prevention (chlamydia, gonorrhea, syphilis). See Doxy-PEP.
• Sterile injection equipment if you inject drugs.

No single method is 100%; combining strategies provides the best protection.

Anyone can ask about PrEP. TeleTest takes a judgment-free, harm-reduction approach - you don't need to justify your request, and you don't need to fit a specific risk profile.

PrEP is most commonly recommended for:

• People with an HIV-positive partner (especially if their partner is not on treatment or doesn't have a consistently undetectable viral load).
• Gay, bisexual, and other men who have sex with men (MSM).
• Transgender people at risk of HIV exposure.
• Sex workers and adult-industry performers.
• People who have multiple sexual partners or partners whose HIV status is unknown.
• People who have had a recent STI (which increases HIV-acquisition risk).
• People who inject drugs and share needles or equipment.
• People who have used PEP more than once.

If any of these apply, PrEP is worth a conversation. The clinician will assess your situation during the consultation.

Yes - particularly for:

• Heterosexual individuals with an HIV-positive partner who is not on consistent treatment.
• People who have condomless vaginal or anal sex with multiple partners.
• People whose partner has elevated HIV-acquisition risk (e.g., MSM, person who injects drugs).

For vaginal or frontal sex, daily oral PrEP is the appropriate regimen. The 2-1-1 on-demand schedule is not recommended for vaginal / frontal exposures because there is insufficient evidence, and drug levels in vaginal tissue build differently than in rectal tissue.

Yes. PrEP is safe and effective for transgender and non-binary patients. Daily oral PrEP can be used alongside estrogen or testosterone therapy. PrEP does not reduce the effectiveness of gender-affirming hormones.

TeleTest does not offer 2-1-1 PrEP for transgender patients. Some guidance discusses 2-1-1 as an option for selected trans women, but data are limited and feminizing hormone therapy may modestly reduce PrEP drug levels. Daily oral PrEP is the more reliable virtual-care option.

• Transgender women - daily oral PrEP through TeleTest, or injectable PrEP through an HIV / sexual-health clinic.
• Transgender men with receptive vaginal / frontal sex - daily oral PrEP (vaginal-tissue drug levels build up more slowly than rectal-tissue levels, so daily is required).
• Non-binary patients - the appropriate regimen depends on the type of sex you're having and what tissue is at risk; the clinician will discuss this during your consultation.

Yes, but daily PrEP is required for HIV-from-injection prevention. On-demand dosing is not effective for blood-borne exposure because consistent drug levels in the blood are needed to block the virus.

Even with PrEP, continue harm-reduction strategies: sterile needles, not sharing equipment, naloxone access. PrEP is a complement to harm reduction, not a replacement.

Yes. If one partner has HIV and the other does not, PrEP for the HIV-negative partner provides an additional layer of protection.

• If the HIV-positive partner is on effective treatment with a consistently undetectable viral load, the risk of sexual transmission is effectively zero (U=U) - PrEP is optional in that case.
• If the HIV-positive partner's viral load is not consistently undetectable (e.g., recently started treatment, treatment gaps), PrEP for the negative partner is strongly recommended.

In Canada, PrEP is available as oral pills and as a long-acting injection.

• Daily oral PrEP is taken once daily and is the standard oral regimen for most patients. TeleTest prescribes this.
• On-demand "2-1-1" oral PrEP is taken around the time of sex. TeleTest only prescribes this for eligible adult cisgender MSM because the evidence and some provincial guidance are strongest for this group. It is not used for vaginal/frontal sex or for injection-drug-use exposure.
• Injectable PrEP is a long-acting injectable medication, Health Canada-approved, given by a healthcare provider as an injection: the first injection, a second injection one month later, then every two months. TeleTest does not prescribe injectable PrEP because it requires in-person administration.

Yes - but only for eligible adult cisgender MSM (men who have sex with men). Some guidelines discuss broader use of 2-1-1 dosing, but TeleTest follows a more conservative eligibility approach based on the populations where 2-1-1 was directly studied (primarily the IPERGAY trial in cisgender MSM).

You may be eligible for on-demand PrEP through TeleTest if you:

• Are an adult cisgender man who has sex with men.
• Have infrequent sexual activity (less often than once or twice a week).
• Can plan dosing at least 2 hours before each sexual encounter (the first dose must be 2-24 hours before sex).
• Do not have hepatitis B (some PrEP medications also suppress hepatitis B - stopping abruptly can cause flare-ups, so daily dosing is required for hepatitis-B-positive patients).

Who is not eligible for 2-1-1 dosing through TeleTest:

• Cisgender women and transgender individuals engaging in vaginal sex (drug levels don't build up reliably in vaginal tissue).
• People who inject drugs (consistent blood drug levels are needed).
• MSM who have frequent or unpredictable sex (daily PrEP is more reliable).

The clinician will discuss whether on-demand or daily PrEP fits your pattern during the consultation.

The 2-1-1 schedule:

• Before sex: take 2 tablets between 2 and 24 hours before sex. Closer to 24 hours before is generally better.
• 24 hours after the first dose: take 1 tablet.
• 48 hours after the first dose: take 1 more tablet.

If you continue having sex over multiple days, take 1 tablet per day throughout, with the final tablet 2 days (48 hours) after your last sexual encounter.

Protection begins 2 hours after the first 2-tablet dose, with peak protection by 24 hours. Skipping the post-sex doses significantly reduces protection - the complete sequence is essential.

Injectable PrEP is a long-acting injection given every 2 months instead of daily pills. It can be a strong fit for patients who:

• Have trouble taking pills consistently.
• Prefer privacy from daily medication.
• Travel frequently and don't want to manage a daily pill supply.

Schedule:

• First injection at month 0.
• Second injection at month 1 (boosts drug levels).
• Ongoing injections every 2 months thereafter.

TeleTest does not prescribe injectable PrEP - it requires in-person administration of the injection, which doesn't fit our virtual model. If you're interested in injectable PrEP, an HIV specialty clinic, a sexual-health clinic, or your family doctor would be the right route. We can still help with daily or on-demand oral PrEP if that fits your situation, or with STI screening and follow-up bloodwork if you're already on injectable PrEP through another provider.

1. Submit a PrEP consultation on teletest.ca (under STD/STI testing - PrEP).
2. Complete the intake - your sexual-health context, exposure pattern, partner status, current medications.
3. Visit the lab for baseline testing (see the required-tests accordion below). The requisition is faxed to your chosen lab.
4. Once results are reviewed, the clinician sends a secure message with the prescription. The prescription is faxed directly to your pharmacy.
5. Pick up PrEP at your pharmacy and start the regimen the clinician recommends.

Before starting PrEP:

• HIV test - PrEP is only for HIV-negative individuals.
• Kidney function (creatinine / eGFR) - daily oral PrEP can affect kidney health in some patients.
• Hepatitis B surface antigen + antibody - some PrEP medications also suppress hepatitis B, so we need to know your status before starting (and before stopping safely).
• Hepatitis C antibody.
• Full STI screening (chlamydia, gonorrhea, syphilis, trichomoniasis).
• Pregnancy test if applicable.

These also serve as your baseline for ongoing monitoring.

A useful clinical pearl: patients with hepatitis B can use daily oral PrEP - some of the medications in the daily PrEP regimen are also active against hepatitis B and can suppress hepatitis-B replication. This is generally a good thing, but it means:

• Use daily PrEP, not 2-1-1. On-demand dosing doesn't maintain enough drug to suppress hepatitis B reliably.
• Do not stop PrEP abruptly without clinician guidance - hepatitis B can flare when the suppressing medication is removed. If you decide to stop PrEP, the clinician will coordinate this safely (often with monitoring or transition to hepatitis-B treatment alone).
• Hepatitis B follow-up (liver function and viral load monitoring) is typically managed by a family doctor or hepatology - the clinician will discuss whether your hepatitis B needs additional management.

After starting oral PrEP, follow-up is usually every 3 months. These visits include:

• HIV testing.
• Review of adherence and side effects.
• Prescription renewal.
• STI screening based on your symptoms, exposure sites, and risk.

Kidney function is checked before starting oral PrEP and then periodically. Some patients need kidney checks more often, especially if they are older, have reduced baseline kidney function, diabetes, high blood pressure, or use medications that can affect the kidneys.

You can also reach out anytime between scheduled visits if you experience side effects, have a new concern, or have a high-risk exposure.

Cost depends on your province and your coverage. General points across the country:

• Some provinces have PrEP-specific public programs that cover the medication for eligible patients - check your provincial AIDS/HIV agency for current details.
• Provincial drug plans may cover PrEP for eligible patients (for example, programs covering people aged 24 and under without private insurance, low-income programs, or other age- or income-based programs). Eligibility rules vary by province - check your provincial drug plan.
• Private insurance plans often cover PrEP.
• Generic options are typically much less expensive than brand-name - ask your pharmacist what's available and the price difference.
• Manufacturer co-pay assistance programs may be available - ask your pharmacist or the prescribing clinician.

TeleTest's consultation fee is separate from medication cost.

Options:

• Check private insurance including employer benefits and student health plans - many cover PrEP.
• Check provincial drug programs - low-income or high-cost programs may help.
• Manufacturer-assistance programs - some PrEP manufacturers offer co-pay assistance for eligible patients.
• Generic options are typically much less expensive than brand-name.
• Community-based HIV organizations can sometimes help navigate access, especially for newcomers, undocumented patients, and patients without provincial coverage.

Most patients tolerate daily oral PrEP well. Common side effects:

• Gastrointestinal: nausea, mild stomach upset, occasional diarrhea - usually mild and resolves within the first 2-4 weeks as your body adjusts.
• Headache or fatigue - similar timeline; usually transient.
• Mild kidney-function changes - uncommon and usually reversible, but more important for patients with reduced baseline kidney function, older age, diabetes, high blood pressure, or medications that can affect the kidneys. For young, healthy patients with normal baseline kidney function, clinically significant kidney problems are uncommon. Kidney function is checked before starting and then periodically; some patients need more frequent monitoring.
• Slight bone-density reduction - clinical trials have observed about a 1% decrease in bone density, which is generally not clinically significant for most people. Changes typically reverse after stopping. Standard bone-health measures (weight-bearing exercise, calcium, vitamin D) are helpful for long-term users.

Seek medical attention for severe symptoms: significant kidney pain, jaundice, severe muscle pain, persistent nausea/vomiting.

PrEP is generally well-tolerated alongside most other medications. A few notes:

• Gender-affirming hormone therapy (estrogen / testosterone) - no clinically significant interaction with daily PrEP. Safe to use together.
• NSAIDs (ibuprofen, naproxen, diclofenac) - chronic high-dose use can compound kidney effects; mention if you use NSAIDs regularly.
• HIV treatment - TeleTest does not manage HIV treatment and does not arrange referrals to HIV specialty clinics. If a TeleTest HIV test comes back positive, you will need to arrange care with an HIV specialist or infectious-disease clinic (your family doctor, a local in-person clinician, or your nearest sexual-health/HIV clinic can help with this) for the transition off PrEP and onto an appropriate HIV-treatment regimen. Don't continue PrEP on its own after a positive HIV result - the medication isn't sufficient as treatment and can risk resistance.
• Hormonal contraception - no significant interaction.

Mention any prescription medications, over-the-counter medications, and supplements in your intake so the clinician can flag any interactions.

TeleTest does not prescribe PrEP to pregnant patients. Pregnancy-period PrEP needs to be managed in a setting that can coordinate with your prenatal care - we're not the right fit for that level of integrated management through virtual care.

That said, daily oral PrEP is considered safe in pregnancy for patients at ongoing risk of HIV (e.g., partner with HIV who is not consistently undetectable). Mother-to-child HIV transmission can be prevented if the pregnant patient avoids acquiring HIV themselves - so PrEP can be appropriate in pregnancy when managed by the right provider.

Where to get PrEP during pregnancy:

• Your prenatal-care provider (family doctor, midwife, or obstetrician).
• An HIV specialty clinic or sexual-health clinic in your area.
• A local public-health unit - many offer free PrEP for eligible pregnant patients.

If you're planning to become pregnant or have just learned you're pregnant while on TeleTest's PrEP, message us through your portal so the clinician can help arrange a transition to a provider better suited to manage pregnancy-period PrEP.

• Daily oral PrEP, missed less than 24 hours late: take the missed dose as soon as you remember, then continue your usual schedule. One missed day still leaves you well-protected.
• Daily oral PrEP, missed more than 24 hours: skip the missed dose, take your next scheduled dose, and continue normally. Don't double-dose.
• Repeated missed doses (2+ days in a week): protection can drop meaningfully. If you've had a high-risk exposure during a stretch of missed doses, contact a clinician (PEP may be appropriate, especially within 72 hours of exposure).

For on-demand (2-1-1) dosing, missing any of the post-sex doses significantly reduces protection for that exposure - the complete sequence is essential.

Do not stop PrEP if you may still have ongoing HIV exposure. Message the clinician first so they can advise on the safest stopping plan.

For oral PrEP, protection decreases after stopping. In many protocols:

• People using PrEP for anal sex continue for at least 2 days after the last exposure.
• People using PrEP for vaginal / frontal sex or injection-drug-use exposure generally continue longer, often 7 days.
• If you're unsure which applies, continue PrEP and ask the clinician.

If you have active hepatitis B, do not stop oral PrEP without clinician guidance because hepatitis B can flare when the underlying PrEP medications are stopped.

If you stop and later restart PrEP, you need repeat HIV testing before restarting.

Reference: EACS HIV Pre-Exposure Prophylaxis Guidelines

Injectable PrEP stays in the body for many months after the last injection. During this "tail period," drug levels gradually fall and may become too low to protect against HIV while still being high enough to create a risk of drug resistance if HIV is acquired.

If you're stopping injectable PrEP and may still be exposed to HIV, guidelines recommend starting another effective HIV-prevention method - often daily oral PrEP - within 8 weeks after the last injection. Follow-up HIV testing is important after stopping injectable PrEP.

TeleTest can prescribe the daily oral PrEP transition for patients coming off injectable PrEP from another clinic. Submit a PrEP consultation and mention your situation in the intake - the clinician will arrange the appropriate baseline testing and bridge prescription.

Estimated risks per act if the source is HIV-positive and no preventive measures are in use:

These risks change substantially with:

• High viral load in the source partner (untreated HIV) - much higher.
• Undetectable viral load in the source partner - effectively zero (U=U).
• Presence of other STIs - increases transmission risk.
• Mucosal damage or trauma - increases risk.
• PrEP use - reduces risk by ~99%.

Reference: Patel et al. (2014). AIDS 28(10):1509-1519.

U=U stands for "Undetectable = Untransmittable." It means that a person living with HIV who is on effective antiretroviral treatment and has had an undetectable viral load for at least 6 months cannot transmit HIV sexually to a partner. This is a well-established scientific consensus backed by multiple large studies.

U=U has changed how mixed-status couples make decisions about PrEP, condom use, and family planning. If your HIV-positive partner is consistently undetectable, the transmission risk from sex is effectively zero - PrEP is optional rather than essential in that case.

No. PrEP only prevents HIV. It does not prevent:

• Chlamydia, gonorrhea, syphilis.
• Mycoplasma genitalium.
• Trichomoniasis.
• Herpes (HSV).
• HPV.
• Hepatitis A, B, or C.

This is why PrEP is usually combined with condoms, regular STI testing, and (for some patients) Doxy-PEP for bacterial-STI prevention.

Most guidelines recommend STI screening every 3 months while on PrEP, with sites tested based on the type of sex you're having (urine for vaginal/penile exposure; throat swab if receptive oral sex; rectal swab if receptive anal sex; blood for syphilis).

The clinician will discuss what makes sense for your pattern. Patients with frequent partner changes or higher-frequency exposure may benefit from more frequent testing - see the STI Testing Subscription for ongoing screening.

Yes. PrEP and Doxy-PEP are different drug classes used in different ways. Studies and clinical practice describe them as not interfering with each other, and they are commonly used together by patients with both HIV and bacterial-STI risk.

Many people who acquire HIV experience a flu-like illness within a few days to several weeks after exposure - this is the body's initial response to the virus. Common symptoms:

• Fever, fatigue, swollen lymph nodes.
• Sore throat.
• Joint and muscle aches.
• Headache, skin rash.
• Diarrhea, night sweats.

Symptoms typically last about 2 weeks but can range from a few days to several months. Some people have no noticeable symptoms at all.

If you've had a high-risk exposure and now have flu-like symptoms:

• Within 72 hours of the exposure: go to an emergency department right away for PEP - it can prevent the infection from establishing.
• Beyond 72 hours, or for testing: submit an STI consultation through TeleTest and mention your concern. Standard 4th-generation HIV testing detects acute infection within about 2-4 weeks of exposure; an HIV RNA / viral load test (available at specialty clinics) can detect even earlier.
• Avoid unprotected sex until you have a definitive result - early HIV infection has very high viral loads and is highly transmissible.

If a follow-up HIV test on PrEP comes back positive (uncommon but possible if you had an exposure shortly before starting PrEP or with imperfect adherence):

• Do not stop PrEP on your own - continuing it briefly while transitioning to full HIV treatment may help prevent resistance development.
• Confirmation testing will be needed to verify the result.
• TeleTest does not arrange HIV-specialist referrals. You will need to connect with an HIV specialist or infectious-disease clinic for transition to a full HIV-treatment regimen. Your family doctor, a local in-person clinician, or your nearest sexual-health/HIV clinic can help with this.

TeleTest consultations are by secure messaging. If you'd like a partner involved in the discussion, you can share your device and conversation with them. Some couples find it useful to make PrEP and prevention decisions together.