Table 3. Patient Assessments and Counseling Topics for Use of Preexposure Prophylaxis
Behavioral risk reductionEffective 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 screeningActivities that increase risk for HIV also increase risk for other STIs, and screening for STI symptoms may be appropriate.6
Pregnancy intent and contraceptionWhile 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 medicationsTDF/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.