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 […]
Goals of PrEP
The ultimate goal of HIV pre-exposure prophylaxis (PrEP) is to reduce the acquisition of HIV infection and its resultant morbidity, mortality and associated cost to individuals and society. Therefore, clinicians initiating the provision of PrEP should: prescribe medication regimens that are proven safe and effective for HIV-negative people who are suitable for PrEP to reduce their risk of […]
Daily PrEP
Daily PrEP is the most commonly prescribed PrEP regimen in Australia. Daily use of TD*/FTC is highly efficacious at preventing HIV transmission in MSM 1, 2, heterosexuals 3, transgender women 4 and people who inject drugs (PWID) 5 in the setting of high medication adherence. A detailed review of these and other studies that have demonstrated the efficacy […]
On-demand PrEP†
On-demand† PrEP involves taking two tablets of TD*/FTC 2–24 hours before a potential sexual exposure to HIV, followed by a third tablet 24 hours after the first dose and a fourth tablet 48 hours after the first dose. If sex continues beyond one day, a user of on-demand† PrEP can stay protected by continuing to take a […]
The choice of PrEP schedule: daily versus on-demand PrEP
Daily PrEP is suitable for all people who are at risk of HIV. Daily PrEP is the only PrEP regimen that is recommended for cisgender women, transgender women on exogenous oestrogen therapy, transgender men who have vaginal sex, and for people who inject drugs (PWID) 6. The Therapeutic Goods Administration (TGA) has not approved this […]