UK guide to PrEP (July 2025)

1 July 2025. Related: Guides, News.

The July 2025 edition of this community guide is on the 2025 UK guidelines. This is an exciting time for PrEP.

Everyone who can benefit from PrEP in the UK should now be able to get it at an NHS clinic. You no longer have to be at high risk.
Everyone now has the option to quick-start PrEP using a double first dose (two pills), working within two hours.
Adherence to daily dosing doesn’t have to be so strict. So long as someone takes four or more doses each week, protection will still be very high.
Event-based dosing can also now be used by everyone. This uses either 2:1:1 or 2:7 dosing.
New info covers starting and stopping PrEP and new versions of PrEP (TAF/FTC and injectables).
All information is based on the UK PrEP guidelines (BHIVA/BASHH) published in July 2025.

The changes are based on recent studies that update our understanding of how PrEP works. Instead of needing to have good drug levels in genital and anal tissue, PrEP efficacy is better explained by drug levels in cells called PBMCs. [1]

Because drug levels in PBMCs are not affected by sex or gender, there are now easier dosing options for cisgender women and for people who are transgender and non-binary.

Other studies show that everyone can now quick-start PrEP with a double dose (two pills) to be protected within two hours. [2, 3]

These changes should also be included in the final guidelines.

Note: UK guidelines are now online, together with similar European guidelines from EACS. [6, 7]

References

Zhang L et al. Model-based predictions of protective HIV pre-exposure prophylaxis adherence levels in cisgender women. Nat Med. 2023 Nov;29(11):2753-2762. doi: 10.1038/s41591-023-02615-x. (13 November 2023).
www.ncbi.nlm.nih.gov/pmc/articles/PMC10667095
Cottrell ML et al. A translational pharmacology approach to predicting outcomes of preexposure prophylaxis against HIV in men and women using tenofovir disoproxil fumarate with or without emtricitabine. J Infect Dis. 2016 Jul 1;214(1):55-64. doi: 10.1093/infdis/jiw077. Epub 2016 Feb 24.
pubmed.ncbi.nlm.nih.gov/26917574
Garrett KL et al. A pharmacokinetic/pharmacodynamic model to predict effective HIV prophylaxis dosing strategies for people who inject drugs. J Pharmacol Exp Ther. 2018 Nov;367(2):245-251. doi: 10.1124/jpet.118.251009. Epub 2018. (27 August 2018).
pubmed.ncbi.nlm.nih.gov/30150483
Cespedes MS et al. (2024) Gender affirming hormones do not affect the exposure and efficacy of F/TDF or F/TAF for HIV preexposure prophylaxis: a subgroup analysis from the DISCOVER trial Transgender Health 9:1 46–52 DOI: 10.1089/trgh.2022.0048.
www.liebertpub.com/doi/full/10.1089/trgh.2022.0048
Marrazzo J et al. HIV Preexposure Prophylaxis With Emtricitabine and Tenofovir Disoproxil Fumarate Among Cisgender Women. JAMA. doi:10.1001/jama.2024.0464. (1 March 2024).
jamanetwork.com/journals/jama/fullarticle/2816036
Major update of UK PrEP guidelines online for public consultation. (HTB October 2024).
i-base.info/htb/48804
Glasgow 2024: Double dose start for oral PrEP in Europe – rapid protection in two hours. (HTB November 2024).
i-base.info/htb/49351