Pre-exposure prophylaxis for HIV: a review for dermatovenereologists

Human immunodeficiency virus (HIV) infection remains a significant public health issue, with 112,883 new diagnoses reported in Europe in 2023. The rise is particularly notable in Eastern Europe, where new cases increased by 20% between 2010 and 2023. Late diagnosis is a major barrier to HIV control, with nearly 50% of new infections in Europe - and up to 60% in Italy - detected at an advanced stage. Dermatovenereologists are key in early detection, as over 90% of people living with HIV show at least one HIV-related dermatologic condition before diagnosis. Thus, dermatovenereology services are well-positioned to promote routine HIV testing and prevention. Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention method but is unevenly implemented across Europe. In Italy, PrEP is mostly prescribed by infectious disease specialists, except at a pioneering sexually transmitted infections (STI) center in Florence where dermatovenereologists can also prescribe it. Expanding this prescribing authority nationwide could improve access and prevention efforts among underserved populations. Integrating PrEP into dermatovenereology would enhance the continuum of care by linking STI screening, treatment, counseling, and HIV prevention, supporting UNAIDS' goal of ending AIDS by 2030. This narrative review summarizes key studies leading to PrEP approval, outlines approved administration methods for at-risk groups, discusses potential side effects, and highlights emerging therapeutic options under regulatory review (such as long-acting PrEP). It aims to equip dermatovenereologists with all the necessary tools to prescribe and manage PrEP effectively during follow-up.