From the Guidelines
PrEP can be prescribed for this 37-year-old male patient with a history of suicidal ideation who is currently stable and not on medications, with the recommended regimen being either daily Truvada or Descovy, or on-demand dosing for men who have sex with men, as supported by the most recent and highest quality study 1. The patient's history of suicidal ideation should be taken into consideration, but it is not a contraindication for PrEP, as neither Truvada nor Descovy has been associated with increased suicide risk, as noted in various studies 1. Before starting PrEP, baseline HIV testing, renal function assessment, hepatitis B screening, and STI testing should be performed, as recommended by the international antiviral society-usa panel 1. The patient should be monitored every 3 months with HIV and STI testing, and renal function should be checked periodically, to ensure the safe and effective use of PrEP. Some key points to consider when prescribing PrEP include:
- The patient's risk of HIV infection, which should be assessed based on their sexual behavior and other factors 1
- The potential benefits and risks of PrEP, including the potential for reduced HIV transmission and the potential for side effects such as renal impairment 1
- The importance of regular follow-up and monitoring, to ensure the safe and effective use of PrEP and to address any concerns or side effects that may arise 1 It is also important to note that PrEP is highly effective at preventing HIV when taken as prescribed, with efficacy exceeding 90%, as supported by various studies 1. Overall, the use of PrEP in this patient can be a highly effective way to reduce their risk of HIV infection, while also taking into consideration their history of suicidal ideation and ensuring their safe and effective use of the medication.
From the FDA Drug Label
You must be HIV-1 negative to start emtricitabine and tenofovir disoproxil fumarate tablets. You must get tested to make sure that you do not already have HIV-1 infection. Do not take emtricitabine and tenofovir disoproxil fumarate tablets for HIV-1 PrEP unless you are confirmed to be HIV-1 negative.
The patient must be tested for HIV-1 and confirmed to be HIV-1 negative before starting emtricitabine and tenofovir disoproxil fumarate tablets for PrEP.
- HIV-1 testing is required to confirm the patient's HIV-1 status.
- The patient's mental health history of suicidal ideation is not directly relevant to the use of emtricitabine and tenofovir disoproxil fumarate tablets for PrEP, as the drug label does not provide information on the use of this medication in patients with a history of suicidal ideation 2.
From the Research
Patient Eligibility for PrEP
- The patient is a 37-year-old male with a history of suicidal ideation, but is currently stable and not suicidal.
- He is not on any medications and is asking for Pre-Exposure Prophylaxis (PrEP).
PrEP Efficacy and Safety
- Studies have shown that PrEP with daily dosing of tenofovir disoproxil fumarate (TDF)/emtricitabine significantly reduces HIV acquisition in men who have sex with men, high-risk heterosexuals, and injection drug users who share injection equipment 3, 4.
- The efficacy of daily TDF/emtricitabine exceeds 90% but is highly correlated with degree of adherence 3.
- TDF/emtricitabine is safe and well-tolerated, with only 2% of people discontinuing PrEP due to adverse effects 3.
Long-term Safety and Efficacy of PrEP
- A study found that emtricitabine and tenofovir alafenamide is safe and effective for longer-term pre-exposure prophylaxis in cisgender men and transgender women who have sex with men 5.
- Another study found that on-demand PrEP represents a valid alternative to daily PrEP for men who have sex with men, providing greater choice in HIV prevention 6.