Portugal's Directorate-General of Health (DGS) has revised its guidance on HIV pre-exposure prophylaxis (PrEP), simplifying how patients on the medication are monitored and opening the door to prescribing in primary care settings and community-based organizations. The changes appear in an update to Norma n.º 001/2024, published on the DGS website and reported by Notícias ao Minuto on Friday.
According to Notícias ao Minuto, the revision has two main aims: making it easier to follow up with people using PrEP — a medication that prevents HIV infection — and allowing the prescription to be issued in these new contexts.
Why it matters
PrEP involves people who do not have HIV taking antiretroviral drugs to lower their chances of acquiring the virus. The DGS norm covers adults and adolescents aged 16 and older who face a heightened risk of infection, according to the document.
By widening where PrEP can be prescribed and loosening the monitoring schedule, the updated guidance could reduce the number of steps between a person at risk and the preventive treatment. Notícias ao Minuto reports that the norm applies to sexually active people at increased risk, who should be told about the benefits of PrEP, the need for a clinical assessment before starting, continuing or stopping it, and the importance of sticking to the prevention plan.
What the updated guidance says
For people who have been on PrEP for a long time and are following the preventive regimen, clinical assessment should take place every three to six months, with the interval set by an individual risk evaluation. Follow-up can be handled by doctors or nurses, in person or remotely, according to the norm.
During those assessments, the guidance calls for monitoring adherence to the prophylaxis, the person's motivation, how well the medication is tolerated, and whether side effects have appeared. The follow-up also includes fourth-generation HIV tests and syphilis serology, along with a check for signs and symptoms of other sexually transmitted infections to decide whether further testing is needed.
The norm also directs that local procedures be set up for unscheduled appointments and for remote consultations. Access to a consultation should be made easier when someone has symptoms pointing to acute HIV infection or other sexually transmitted infections, Notícias ao Minuto reports.
When PrEP should be considered — and stopped
The DGS document lists several situations in which starting PrEP should be weighed. These include certain sexual practices without consistent condom use that are tied to risk factors, a diagnosis of another sexually transmitted infection, previous use of post-exposure prophylaxis with continued risk, and injecting drugs without sterile equipment.
Before PrEP begins, the guidance requires a clinical assessment covering the risk of HIV and other STIs, the person's ability to adhere to the regimen, kidney function, possible drug interactions, and any conditions that could raise the chance of adverse effects.
The norm also sets out when PrEP should be stopped. These include a diagnosis of HIV infection, intolerance or drug toxicity, failure to follow the prophylactic regimen, and the person's own decision to stop.
After discontinuation, the result of a fourth-generation HIV test taken at the time of stopping must be recorded in the clinical file, with the test repeated four weeks later. For people with chronic hepatitis B infection, the guidance provides for monitoring after PrEP is stopped because of the risk that the disease could reactivate.
The update is the latest step in Portugal's effort to make HIV prevention more accessible through routine health services and community organizations rather than specialized clinics alone. What to watch: how quickly primary care units and community organizations begin issuing PrEP prescriptions under the revised norm.
