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There is no single best PrEP option for everyone. In the United States, the choices covered by current CDC guidance include two daily pills—F/TDF and F/TAF—and injectable cabotegravir (CAB) and lenacapavir (LEN). The right comparison starts with your HIV exposure route, then weighs the dosing schedule, medical considerations, and ability to keep up with testing and follow-up. A clinician can help decide which option is appropriate for you.
Compare the options at a glance
PrEP is prescription medication used to reduce the chance of acquiring HIV. The options differ in the routes and populations for which they are recommended, as well as how often medication is taken or administered. The table summarizes CDC guidance; it is not a substitute for an individual assessment. See the CDC Clinical Guidance for PrEP and its 2025 lenacapavir recommendation.
| Option | Who CDC guidance covers | Routine | Considerations |
|---|---|---|---|
| F/TDF (emtricitabine/tenofovir disoproxil fumarate) | People with sexual or injection-drug-use risk factors | One pill every day | Kidney function needs consideration; taking the pill consistently matters. |
| F/TAF (emtricitabine/tenofovir alafenamide) | People with sexual transmission risk, except people likely to acquire HIV through receptive vaginal sex; this route has not been studied for prevention with F/TAF | One pill every day | Kidney function needs consideration; taking the pill consistently matters. |
| CAB (cabotegravir) | People with sexual transmission risk | Intramuscular injection, a second dose one month later, then every two months | Returning for injections on schedule matters. Injection-site reactions are commonly reported and are generally mild or moderate. |
| LEN (lenacapavir) | People weighing at least 77 pounds (35 kg) who would benefit from PrEP, under CDC’s 2025 recommendation | Subcutaneous injection every six months | Injection-site reactions were the most common adverse events in the trial report summary. |
CDC strongly recommends LEN for people who meet the weight threshold and would benefit from PrEP, based on high-certainty evidence. That recommendation does not make LEN the right choice for every individual; eligibility and suitability still need clinical review.
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If HIV exposure could occur through sex
CDC lists F/TDF and CAB for sexual transmission risk. F/TAF is also an option for sexual transmission, but not for people likely to acquire HIV through receptive vaginal sex, because it has not been studied for prevention through that route. LEN is recommended by CDC for people who would benefit from PrEP and meet the weight threshold, rather than being described in the cited recommendation as limited to one sexual exposure route.
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If exposure could occur through injection drug use
CDC lists F/TDF for injection-drug-use risk. Do not assume that evidence or recommendations for one PrEP medicine automatically apply to another route or population. Talk with a clinician about your exposure circumstances and which option is supported for them.
Match the schedule to your life
Daily PrEP pills
F/TDF and F/TAF are taken every day. A pill routine may be convenient for someone who prefers self-administered medication, but its effectiveness depends on taking it consistently. Consider how travel, shift work, privacy, or difficulty remembering a daily dose might affect your routine.
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CAB injections
CAB begins with an injection followed by another one month later, then continues every two months. This means fewer medication-taking days than with a daily pill, but it requires planned clinic visits and timely returns. CDC cautions that missed or delayed injections can compromise protective drug levels.
LEN injections
LEN is administered under the skin every six months. Fewer scheduled injections may appeal if a daily pill routine is difficult, but the schedule still depends on receiving each dose on time and staying connected to clinical care. Less frequent dosing is not the same as no follow-up.
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Do not create your own dosing schedule
The options above describe the routines in CDC guidance. The 2-1-1 or event-driven F/TDF schedule is not the standard FDA-approved schedule and is not recommended by CDC. Do not start, stop, switch, or change a PrEP schedule without clinical guidance.
Factor in kidney function and other medical considerations
Oral tenofovir-based PrEP requires attention to kidney function, and severe kidney impairment can make oral options unsuitable. CAB may be useful for some people with serious kidney disease. The appropriate choice also depends on individual contraindications, possible drug interactions, pregnancy considerations, and other health factors; a clinician should review these rather than relying on a general comparison.
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CAB injections can cause injection-site reactions, which are commonly reported and generally mild or moderate. In the LEN trial report summary, injection-site reactions were the most common adverse events. Ask a clinician what to expect with a specific medicine and how to report a problem.
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Understand what the effectiveness figures do—and do not—mean
CDC says oral or injectable PrEP reduces sexual HIV risk by about 99% when taken as prescribed. This is a CDC summary estimate, not a guarantee for an individual. For HIV risk from injection drug use, CDC reports at least a 74% reduction with oral PrEP taken as prescribed; the estimate is based on tenofovir alone and not necessarily daily use, so it is not a direct comparison of every regimen. See the CDC clinical guidance for these qualifications.
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In its 2025 LEN recommendation, CDC summarized trial results over 52 weeks as 100% efficacy among females and 96% in a primarily male trial population, compared with estimated background HIV incidence. These are trial-specific results, not a head-to-head comparison against daily pills and not a prediction of any one person’s protection. The recommendation was published in the CDC Morbidity and Mortality Weekly Report.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Plan for testing and continued care
A clinician must confirm you do not have HIV before starting PrEP and arrange appropriate testing and assessments while you use it. An at-home test does not replace the clinical testing and follow-up required for PrEP care. If you think you may have acquired HIV or have questions about a missed dose or injection, contact a clinician promptly rather than changing your regimen on your own.
PrEP is one part of HIV prevention. It does not prevent other sexually transmitted infections or pregnancy, as the CDC consumer guidance explains. Discuss other prevention measures that fit your circumstances.
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Ask these questions before choosing
- Which exposure routes and circumstances should the option cover?
- Can I reliably take a pill every day, or is it more practical for me to attend injection visits on schedule?
- Do kidney function, other health conditions, pregnancy considerations, or my current medicines affect the choice?
- What testing and follow-up will I need, and how will I manage a missed dose or visit?
- What will my insurance or local program cover? CDC notes that many insurance plans and state Medicaid programs cover some form of PrEP, but coverage for a particular person or option is not established by that general statement.
CDC’s 2025 LEN report also summarizes national assessments in which approximately one half of oral daily PrEP users discontinued within 6–12 months. That figure does not mean every discontinuation reflects medication failure, and an injection schedule does not guarantee continued use. It is a reason to discuss which routine you are most likely to sustain, not a ranking of the options.
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