HIV testing
All patients whose sexual or drug injection history indicates the recommendation or consideration of pre-exposure prophylaxis (PrEP), and who are interested in taking PrEP, must undergo laboratory testing. The tests identify those for whom this intervention would be harmful, or in whom it could present specific health risks that would require close monitoring. HIV testing […]
Concerns about TD* or FTC resistance
Overall, the risk of developing TD* or FTC resistance among participants on PrEP is low 9. According to a World Health Organization (WHO) meta-analysis of HIV resistance data from randomised clinical trials of PrEP, participants on PrEP versus placebo who started PrEP at the time of acute HIV infection had a higher risk of developing resistance, with more […]
Assessment of renal function at baseline
In HIV-positive patients, the use of tenofovir was reviewed in a meta-analysis and was associated with a statistically significant loss of renal function, with the effect being judged as clinically modest 12. Tenofovir use was not associated with increased risk of fractures, hypophosphataemia or severe proteinuria 12. Rarely, proximal renal tubular dysfunction (including Fanconi syndrome) […]
Assessment and management of sexually transmissible infections at baseline
Individuals at risk for HIV infection are also at high risk for STIs. Clinicians should screen for STIs (specifically gonorrhoea, chlamydia and infectious syphilis) using the standard-of-care tests and procedures, and manage any detected STI as recommended by the Australian STI Management Guidelines 23. Importantly the presence of an STI at baseline should not delay the commencement of […]
Assessment of hepatitis A, B and C status
Patients being suitable for PrEP can also be at risk of acquiring hepatitis A, hepatitis B virus (HBV) infection 25 and hepatitis C virus (HCV) [infection 26. Hepatitis A, HBV and HCV infection status should be documented by screening serology when PrEP is initiated. Vaccination against hepatitis A and HBV is recommended for all susceptible priority populations, […]
Assessment of bone health
Low bone mineral density (BMD) was observed at baseline in approximately 10% of individuals receiving TD*/FTC for PrEP in the IPREX study 29. Individuals should be counselled about the effects of TD* on BMD and counselled to decrease alcohol and cigarette use, to undertake weight-bearing exercise and ensure their diet provides adequate amounts of calcium […]
Assessment for pregnancy in women of childbearing age
The risk of HIV transmission to women increases by over two-fold when they are pregnant 32. As reviewed recently, current evidence suggests that PrEP can be used safely during pregnancy and breastfeeding 33. The use of TD*-containing regimens by HIV positive women throughout pregnancy has not been associated with adverse pregnancy outcomes, but lowered BMD has been […]
References
Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). National HIV testing policy. February 2017. Available at: www.testingportal.ashm.org.au/hiv/types-of-hiv-diagnostic-tests (last accessed 18 July 2019). Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). Post-exposure prophylaxis after non-occupational and occupational exposure to HIV: Australian National Guidelines (Second edition). August 2016. Available at: https://www.ashm.org.au/HIV/PEP/ (last accessed 18 July […]