New guideline on pre-exposure and postexposure HIV prevention

Multiple pre-exposure (PrEP) and postexposure (PEP) treatments are now available to prevent HIV infection. An updated Canadian guideline published in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250511 contains 31 recommendations and 10 good practice statements to help clinicians and other health care professionals offer these safe and effective options to teen and adult patients.

The guideline is published on World AIDS Day, December 1, 2025, to raise awareness of new approaches to prevention.

Pre-exposure prophylaxis involves an HIV-negative person starting antiretroviral medications before potential HIV exposures occur in order to prevent infection. Postexposure prophylaxis involves taking 28 days of antiretrovirals right after a potential exposure to HIV.

“Canada is not at all on track to achieve its goal of eliminating HIV as a public health threat by 2030. Our aim with this guideline is to support front-line health care providers, policy-makers, community members, and others in expanding the use of these safe and effective tools for preventing HIV,” says Dr. Darrell Tan, lead author and infectious disease physician at St. Michael’s Hospital, Toronto, Ontario. “A wide array of PrEP and PEP options now exists in Canada. We need to urgently expand their use until all people have equitable access to prevention strategies that they find suitable.”

HIV infections in Canada are concentrated in specific populations, with 38% of new infections in gay, bisexual, and other men having sex with men (GBM); 25% in people who inject drugs (PWID); and 4% in GBM-PWID. More than one-third of infections occur in females. Some Indigenous communities are particularly heavily affected, with more cases in Saskatchewan and Manitoba than the national average.

The guideline, an update to 2017 guidance, was developed through the Canadian Institutes of Health Research (CIHR) Pan-Canadian Network for HIV and STBBI (sexually transmitted and blood-borne infections) Clinical Trials Research (CTN+). It includes easy reference tables with recommendations on medication regimens, indications, monitoring, and more.

Key differences from the 2017 guideline include the “explicit inclusion of self-identified need as a reason for PrEP initiation” and the expanding range of available PrEP choices, with newer regimens including an injection given every 2 months.

The authors’ aim is to support clinical decision-making in primary care, infectious diseases, emergency medicine, sexual health, nursing, pharmacy, and related disciplines, as well as community workers who promote PrEP and PEP.

“Because lack of PrEP and PEP awareness among key populations and clinicians is a common barrier to implementation, public health officials, professional societies, and other trusted authorities should play leadership roles in promoting these strategies in collaboration with community organizations and tracking uptake in conjunction with HIV surveillance data,” the authors write. “Information should be framed in a positive light to counteract the stigma and apprehension that sometimes surround PrEP and PEP.”