HIV pre-exposure prophylaxis: It is time to consider harm reduction care for adolescents in Canada

Sean Leonard; Tatiana Sotindjo; Jason Brophy; Darrell H S Tan; Nancy Nashid

doi:10.1093/pch/pxac115

HIV pre-exposure prophylaxis: It is time to consider harm reduction care for adolescents in Canada

Paediatr Child Health. 2023 Mar 22;28(6):338-343. doi: 10.1093/pch/pxac115. eCollection 2023 Oct.

Authors

Sean Leonard¹, Tatiana Sotindjo², Jason Brophy³, Darrell H S Tan⁴, Nancy Nashid⁵

Affiliations

¹ Department of Paediatrics, Western University, London, Ontario, Canada.
² Division of Adolescent Medicine and Division of Paediatric Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada.
³ Division of Paediatric Infectious Diseases, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
⁴ Division of Infectious Diseases, St Michael's Hospital, Toronto, Ontario, Canada.
⁵ Division of Paediatric Infectious Diseases, Department of Paediatrics, Western University, London, Ontario, Canada.

Abstract

Youth (aged 15 to 29 years) account for one quarter of new HIV cases in Canada. Of those, men-who-have-sex-with-men make up one third to one half of new cases in that age range. Moreover, Indigenous youth are over-represented in the proportion of new cases. The use of emtricitabine/tenofovir disoproxil fumarate as pre-exposure prophylaxis (PrEP) significantly reduces the risk of HIV acquisition in adults. Its use was expanded to include youth over 35 kg by the U.S. Food and Drug Administration in 2018. However, PrEP uptake remains low among adolescents. Prescriber-identified barriers include lack of experience, concerns about safety, unfamiliarity with follow-up guidelines, and costs. This article provides an overview of PrEP for youth in Canada, and its associated safety and side effect profiles. Hypothetical case vignettes highlight some of the many demographics of youth who could benefit from PrEP. We present a novel flow diagram that explains the baseline workup, prescribing guidelines, and follow-up recommendations in the Canadian context. Additional counselling points highlight some of the key discussions that should be elicited when prescribing PrEP.

Keywords: Adolescent health; Counselling; HIV; Pre-exposure prophylaxis.