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HIV Pre-exposure Prophylaxis (PrEP) Testing

Test code(s) 37106, 37133, 37136, 37138

Pre-exposure prophylaxis (PrEP) is a protocol that decreases the risk of acquiring HIV infection in people who do not have HIV, but are at high risk of becoming infected. The PrEP protocol includes the use of anti-retroviral medication. The CDC has developed guidelines that describe the rationale of PrEP, the patient populations for whom PrEP should be considered, and the management of patients who are prescribed PrEP therapy.

Patient management for PrEP includes laboratory testing before and during the PrEP protocol. The CDC guidelines indicate that persons who are under consideration for PrEP, and who are interested in taking PrEP voluntarily, should undergo laboratory testing to identify those for whom this intervention would be harmful or for whom it would present specific health risks that would require close monitoring (see Table).1‑4 In addition, as part of routine follow-up every 3 months, patients should be tested to confirm HIV-negative test status and assess for adverse effects.

Links to the current CDC guidelines are found at: www.cdc.gov/hiv/risk/prep/index.html.

Before beginning PrEP, patients should be tested for infection with HIV, hepatitis C virus (HCV), hepatitis B virus (HBV), syphilis, chlamydia, and gonorrhea; individuals who may become pregnant should also receive a serum pregnancy test.1

For transgender patients, the decision to test for pregnancy may involve patient preference, potential fetal risk, and effect of hormonal therapy on test performance. Select the PrEP panels for males, if pregnancy testing is not indicated.

The Quest Diagnostics PrEP baseline panels include tests for each of the above (see Table).

Follow-up testing at clinically relevant intervals is recommended to assess continued HIV-negative status, kidney function, pregnancy for individuals who may become pregnant, and infection with syphilis, chlamydia, and gonorrhea. For transgender patients, the decision to test for pregnancy may involve patient preference, potential fetal risk, and effect of hormonal therapy on test performance. Select the PrEP panels for males if pregnancy testing is not indicated.

The Quest Diagnostics PrEP monitoring panels include tests for each of the above (see Table).

The CDC recommends testing for sexually transmitted infections from likely anatomic sites of exposure.5 The HIV PrEP panels from Quest include tests for chlamydia and gonorrhea from urogenital specimens. Quest Diagnostics also offers separate test codes for testing from rectal and throat specimens:

  • CT/NG Rectal: 16506(X)a
  • CT/NG Throat: 70051(X)a

aPlease use a dedicated requisition for testing each additional anatomic site.

For information on HIV testing:
https://education.questdiagnostics.com/faq/FAQ106

For information on HCV testing:
https://education.questdiagnostics.com/faq/FAQ194

For information on Chlamydia/Gonorrhoea testing:
https://education.questdiagnostics.com/faq/FAQ154

 

References

  1. US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States—2017: Update: a clinical practice guideline. Atlanta: Centers for Disease Control and Prevention; 2017. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2017.pdf.
  2. Murnane PM, Celum C, Mugo M, et al. Efficacy of preexposure prophylaxis for HIV-1 prevention among high- risk heterosexuals: Subgroup analyses from a randomized trial. AIDS. 2013;27:2155-2160.
  3. Grohskopf LA, Chillag KL, Gvetadze R, et al. Randomized trial of clinical safety of daily oral tenofovir disoproxil fumarate among HIV-uninfected men who have sex with men in the United States. J Acquired Immune Defic Syndr. 2013;64:79-86.
  4. World Health Organization. Guidance on oral pre-exposure prophylaxis (PrEP) for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV: recommendations for use in the context of demonstration projects. Geneva, Switzerland: WHO, 2012. http://www.who.int/hiv/pub/guidance_prep/en/.
  5. Centers for Disease Control and Prevention website. 2015 sexually transmitted diseases treatment guidelines. https://www.cdc.gov/std/tg2015/default.htm. Accessed October 25, 2018.

 

This FAQ is provided for informational purposes only and is not intended as medical advice. A clinician’s test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education, clinical expertise, and assessment of the patient.

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Effective 02/11/2019 to present

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