Prescribing PrEP

In some people there have been concerns about bone density and the risk of fracture when taking PrEP. This is actually an extremely rare side effect. What we can say is if you have patients with pre-existing bone density issues or they are at high risk of osteopetrosis, it is worthwhile to consider a bone density scan before they start PrEP. Remember there are a number of different ways that we can help optimise bone density in our patients.

How do you guide people on how to take PrEP? Currently the recommendations in Australia are that PrEP is taken every day. What I’d like to talk to my patients about is to find something that they do on a regular basis and tie taking the medicine to that. Say, for example, if they take another medication in the morning, that’s a great time to take PrEP as well. Or, if they regular do something like brushing their teeth before they head out for the day, make sure that they put the PrEP next to the toothbrush.

If you discover that a person is HIV positive during the screening process of starting PrEP, the most important thing is do not start PrEP. PrEP is not appropriate for this person, this person needs to be on HIV treatment which involves three agents that are active against HIV. Truvada or PrEP only has two agents and it’s important that we offer full, effective, potent treatment for HIV in people who have recently been diagnosed with infection.