PrEPPEP

PrEPPEP is a term used to describe an integrated HIV prevention approach that combines elements of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) within a single care pathway. The concept is not an official medical protocol in most guidelines, but it appears in public health discussions as a way to provide continuous protection for people with intermittent or uncertain exposure risk.

In practice, PrEPPEP envisions ongoing PrEP use alongside rapid access to PEP after a suspected exposure, with clear guidance on when to initiate, overlap, or transition between strategies. This could include starting PrEP before a known high-risk period, using PEP after potential exposure, and returning to PrEP after completing PEP or using a bridging strategy during periods of change in risk. The aim is to reduce gaps in protection when exposure risk fluctuates or adherence to a single approach is challenging.

Medications and monitoring commonly align with standard PrEP and PEP practices. PrEP typically uses a two-drug regimen such as tenofovir disoproxil fumarate with emtricitabine (TDF/FTC) or alternatives like tenofovir alafenamide with emtricitabine (TAF/FTC). PEP usually involves a 28-day course of similar NRTI-backbone therapy, often combined with an integrase inhibitor, with choices tailored to guidelines, safety, and drug interactions. Initiation of PEP requires timely assessment to exclude acute HIV infection, and both PrEP and PEP require baseline and periodic monitoring of renal function, bone health, hepatitis B status, and HIV testing.

PrEPPEP is discussed in relation to populations at higher risk, including men who have sex with men, transgender individuals, sex workers, and people in serodiscordant relationships, as well as in settings such as sexual health clinics and harm-reduction programs. Evidence is limited, and more research is needed to establish best practices, dosing, and monitoring for wide implementation. See also PrEP and PEP.