PrEP for Adolescents: What Teens Should Know

When we think about keeping teens safe, there’s a lot that comes to mind. It’s the teenage years when humans naturally take more risks. So, whether it’s preventing a sports injury or just trying to get them to eat well, there’s a lot for parents to consider. One topic that is sometimes trickier for parents and teens involves the risks with sexual activity. Although the risks are many, one is the risk of HIV infection. For a few years, there’s been a medication option to help prevent HIV infection. The updated 2021 guideline now emphasize that all sexually active people (including teens) be educated about this regimen. (Most of the information in today’s article comes from this 2021 clinical practice guideline from the US Public Health Service).

What can help prevent HIV infection?

PrEP is a medication regimen that helps prevent HIV infection. It stands for “pre-exposure prophylaxis.” In other words, it’s something to take before being exposed (“pre-exposure”) to HIV to prevent (“prophylax”) an infection. 

There are a few different possible medications and regimens. (For those who want the details, medications may include: tenofovir disoproxil fumarate or tenofovir alafenamide with emtricitabine. For some people, injections of cabotegravir every two months may be an option).

PrEP can be prescribed to someone at high risk for an HIV infection.

Who should take PrEP?

PrEP is actually something that can be offered to anyone at high risk who weighs more than 35kg (77 pounds). So, it’s not based on a specific age. It’s based on a person’s weight. This means PrEP prescriptions can include teens and adolescents. A teenager’s physician may prescribe it if the teen is at a high risk (and at an appropriate weight). The 2021 guidelines state that “All sexually active adult and adolescent patients should receive information about PrEP.”

What makes someone high risk for HIV infection?

How does a teen know if they need PrEP? Their physician will help them figure out their risk.

It’s ideal for teens to be honest with their health care team. Aside from HIV risk, there are other health issues that can come up. A teen’s doctor is often in a great position to be helpful with whatever arises.

Some of the topics a clinician may cover when helping figure out someone’s risk of HIV infection include:

• sexual activity
• IV drug use
• whether a sexual partner is infected with HIV
• whether someone has had a bacterial sexually transmitted infection (STI) in the last 6 months
• review of other medications already taken and other medical conditions

Although these topics may be addressed, current guidelines state that if a person requests a PrEP prescription, then their physician can consider prescribing even without knowing the exact risk for HIV. This isn’t ideal because very useful information can come with the initial questions. However, this allows some wiggle room for someone who isn’t comfortable or able to share some details.

Lab tests before starting PrEP in teens

Some lab work is need before considering PrEP.

• Before starting prep, an HIV test is needed. It needs to be negative (no HIV infection) in order to start PrEP. Depending on the medication regimen, HIV testing also needs to be done regularly while taking PrEP.
• Health care providers may also check for other sexually transmitted infections.
• Most PrEP regimens require lab work to check the kidneys. 
• Clinicians may also check a lipid panel (including cholesterol) and hepatitis B. 

In other words, it’s not only common, but necessary to have a few lab tests done when considering this medication. 

Even though blood work may seem like a big deal, it’s very routine. For many, is absolutely worth the hassle. It means being able to take a potentially life-saving medication!

A few common questions regarding PrEP in teens

This is a topic best addressed between a teen and their physician. I write here today so that more can be aware it’s an option. That being said, there are a few more general questions that arise.

Can someone get a PrEP prescription for their partner?

In some cases, prescriptions for other STIs can be obtained for someone’s partner who is not present at an appointment. This is called expedited partner therapy (and it is after someone is diagnosed, not as part of a prevention plan). It does not apply to PrEP. Prescriptions cannot be provided if the patient themselves does not complete the most essential labs (like the HIV test). In other words, someone cannot get a PrEP prescription for a friend or partner.

Are condoms still necessary if someone is taking PrEP?

PrEP only helps prevent HIV infection. It does not prevent or treat other STIs. It does not prevent pregnancy. Therefore, in most cases, condoms are still important.

At what age can someone take PrEP?

As mentioned earlier, there is not a specific age cutoff. If someone meets the other criteria and they weigh more than 35 kg (77 pounds), then they may be a candidate for PrEP, even if they are a teenager. This is something their own physician can help address.

Summary: Pre-exposure Prophylaxis (PrEP) for HIV is now an option for many more people.

If someone is sexually active or is the parent of a sexually active teen, they can ask their doctor if PrEP should be considered. It helps lower the risk of HIV infection.

Disclaimer:

This is for information only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. Please see the complete disclaimer.

Maya M. Mahmood, D.O., FAAP is a board-certified pediatrician and mom. She is passionate about parents having evidence-based information to help their families be healthier.  Subscribe to the newsletter for regular updates.