American Board of Internal Medicine (ABIM) Certification Practice Exam

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What is the primary medication used for pre-exposure prophylaxis (PrEP) against HIV?

Rilpivirine
Tenofovir-emtricitabine
Lamivudine
Abacavir

The correct answer is: Tenofovir-emtricitabine

The primary medication used for pre-exposure prophylaxis (PrEP) against HIV is tenofovir-emtricitabine. This combination drug is specifically recommended for individuals at high risk of contracting HIV, providing an effective way to reduce the likelihood of infection when taken consistently. Tenofovir is a nucleotide reverse transcriptase inhibitor that prevents the replication of HIV, while emtricitabine, which is a nucleoside reverse transcriptase inhibitor, complements this effect by further inhibiting viral replication. The combination leverages the strengths of both agents to provide robust prevention, hence its designation as the standard PrEP regimen. The other medications listed, although antiviral, are not recommended as first-line options for PrEP. Rilpivirine, for example, is used in the treatment of HIV but not specifically for prevention. Lamivudine and abacavir are also antiretroviral agents but do not have the same level of efficacy and supporting evidence for use in the PrEP context as tenofovir-emtricitabine does. Therefore, tenofovir-emtricitabine is the cornerstone medication for PrEP in individuals at risk of HIV exposure.