In the United States, PrEP options include two daily pills—F/TDF and F/TAF—and two injections: cabotegravir (CAB) every two months after its first-month follow-up dose, and lenacapavir (LEN) every six months. The right choice depends first on the type of HIV exposure you need protection from, then on medical factors and which schedule you can keep up with. A clinician can help confirm eligibility and choose a regimen; none is best for everyone.
What are the current PrEP options?
The CDC describes these four medication options. The distinctions that matter most are the exposure routes each recommendation covers and the schedule involved.
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| Option | Schedule | CDC recommendation and key distinction |
|---|---|---|
| Oral F/TDF (emtricitabine/tenofovir disoproxil fumarate) | One pill daily | Recommended for people with sexual or injection-drug-use HIV risk. Kidney function needs consideration. CDC clinical guidance |
| Oral F/TAF (emtricitabine/tenofovir alafenamide) | One pill daily | Recommended for sexual HIV risk, except for people likely to acquire HIV through receptive vaginal sex; it has not been studied for prevention by that route. Kidney function needs consideration. CDC clinical guidance |
| Injectable CAB (cabotegravir) | Intramuscular injection, then another dose one month later, then every two months | CDC lists it for sexual HIV risk. Keeping injection appointments matters; injection-site reactions are commonly reported and generally mild or moderate. CDC clinical guidance |
| Injectable LEN (lenacapavir) | Subcutaneous injection every six months | CDC strongly recommends it as a PrEP option for people weighing at least 77 pounds (35 kg) who would benefit from PrEP. The recommendation does not, by itself, establish that evidence for one exposure route applies to every other route. CDC’s 2025 recommendation |
These are prescription prevention medicines, not over-the-counter products. Do not start, stop, switch, or alter a PrEP schedule without clinical guidance.
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Which PrEP options fit the type of exposure?
Sexual exposure
CDC lists F/TDF, F/TAF (with the receptive-vaginal-sex limitation above), and CAB for sexual HIV risk. LEN is also a CDC-recommended option for people who would benefit from PrEP and meet its weight threshold. A clinician can help determine which recommendations fit your circumstances; do not assume that evidence for one route or population transfers automatically to another. CDC clinical guidance; CDC LEN recommendation
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Injection-drug-use exposure
F/TDF is the oral option CDC recommends for people with injection-drug-use risk. CDC reports at least a 74% reduction in HIV risk from injection drug use when oral PrEP is taken as prescribed; its estimate is based on tenofovir alone and is not necessarily based on daily use. It is not a head-to-head comparison of every PrEP regimen. CDC clinical guidance
How do daily pills compare with PrEP shots?
Daily pills: a recurring home routine
F/TDF and F/TAF are taken every day. That avoids scheduled injection visits, but protection depends on taking the medicine consistently. Think about whether a daily routine is realistic for you, including during travel, changing work hours, or disruptions to your usual schedule.
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Injections: fewer dosing days, planned appointments
CAB begins with a second injection one month after the first, then continues every two months. LEN is administered every six months. A longer interval between doses may suit someone who finds daily pills difficult, but it does not remove the need for timely care, testing, and follow-up. With CAB, CDC cautions that missed or delayed injections can compromise protective drug levels. CDC clinical guidance; CDC LEN recommendation
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How effective is PrEP?
CDC says oral or injectable PrEP taken as prescribed reduces sexual HIV risk by about 99%. This is a summary estimate, not a guarantee for an individual; taking pills consistently and attending injection appointments as scheduled are important. For injection-drug-use risk, CDC gives the separate oral-PrEP estimate described above. CDC clinical guidance
For LEN, CDC’s 2025 recommendation summarizes trial results over 52 weeks: 100% efficacy among females and 96% among a primarily male trial population compared with estimated background incidence. These are results from that trial analysis, not a direct comparison with daily oral PrEP or a promise of personal protection. CDC MMWR, September 18, 2025
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What medical factors should affect the choice?
Kidney function and other health considerations
Oral tenofovir-based PrEP requires attention to kidney function. Severe kidney impairment can make oral options unsuitable, while CAB may be useful for some people with serious kidney disease. The medicines also differ in contraindications and potential drug interactions; pregnancy considerations and other individual factors need clinician review. CDC’s guidance provides kidney-function thresholds, but a clinician must assess how they apply to you. CDC clinical guidance
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Injection-site reactions are commonly reported with CAB and are generally mild or moderate. In the LEN trial report summary, injection-site reactions were the most common adverse events. Ask a clinician about the side effects and other risks relevant to the particular medicine you are considering. CDC clinical guidance; CDC LEN recommendation
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What testing and follow-up does PrEP require?
A clinician must confirm that you do not have HIV before you start PrEP and arrange appropriate testing and assessments while you use it. An at-home test is not a substitute for the testing and follow-up required in PrEP care. Ask the clinic what appointments and tests your chosen regimen requires, and how to contact them if you miss a visit or have questions about a dose. CDC clinical guidance
Questions to take to a PrEP clinician
- Which options are recommended for my type of HIV exposure?
- Do my kidney function, other health conditions, medicines, or pregnancy considerations affect the choices?
- What is the exact dosing schedule, and what should I do if I miss a pill or injection appointment?
- What HIV tests, other assessments, and follow-up visits will I need?
- What does my insurance or state Medicaid program cover, and what costs should I confirm with the clinic and insurer?
CDC notes that many insurance plans and state Medicaid programs cover some form of PrEP, but this does not confirm coverage under an individual plan. Verify your own benefits and local availability with your insurer and a PrEP provider. CDC: Preventing HIV with PrEP
What PrEP does not prevent
PrEP reduces the chance of getting HIV but does not prevent other sexually transmitted infections or pregnancy. Depending on your needs, discuss additional prevention methods and sexual-health care with a clinician. CDC: Preventing HIV with PrEP
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