| Screening/Counseling | Rationale |
|---|---|
| Behavioral risk reduction | Effective use of PrEP depends on synergy with motivational interviewing or multifaceted interventions to reduce high-risk sexual practices and/or injection drug use.38 |
| STI screening | Activities that increase risk for HIV also increase risk for other STIs, and screening for STI symptoms may be appropriate.6 |
| Pregnancy intent and contraception | While PrEP is FDA approved for use during pregnancy and is potentially a valuable tool in preventing transmission during that time, the safety of PrEP for the developing fetus is not well studied; this should be discussed with any patient hoping to conceive.6,34 |
| Alcohol and drug abuse (including inhaled stimulants and amyl nitrate) | These may increase risk of renal and hepatic side effects and decrease adherence to the PrEP regimen.6 |
| Use of renally cleared medications | TDF/FTC is renally cleared, and drug concentrations will be higher when used with other renally cleared medications, including acyclovir and other antiretrovirals.39 |
| Risk for bone loss (including possible measurement of bone density) | Bone loss without fracture was noted in some studies.7,9 |
FDA, US Food and Drug Administration; PrEP, preexposure prophylaxis; STI, sexually transmitted infection; TDF/FTC, tenofovir/emtricitabine.