Truvada PrEP Office Follow-Up Schedule
For patients on Truvada (emtricitabine/tenofovir disoproxil fumarate) for PrEP, follow-up visits should occur every 3 months for HIV testing and STI screening, with creatinine assessment every 6 months. 1, 2
Every 3 Months (Quarterly Visits)
HIV Testing
- Perform combination HIV antigen-antibody assay at each visit 1, 2
- Do not prescribe more than a 90-day supply of Truvada without documented negative HIV testing 1, 2
- If acute HIV infection is suspected based on symptoms or recent high-risk exposure, add HIV RNA testing 1, 2
STI Screening
- Screen all potentially exposed anatomic sites (urine, throat, anal, vaginal) for gonorrhea and chlamydia using nucleic acid amplification testing 1, 2
- Perform syphilis serology 1, 2
Adherence and Risk Assessment
- Assess medication adherence and provide counseling 1, 2
- Evaluate ongoing risk behaviors 2
- Provide condoms 2
Pregnancy Testing
- Test women of childbearing potential at each visit 2
Every 6 Months
Renal Function Monitoring
- Measure serum creatinine and calculate estimated glomerular filtration rate (eGFR) 1, 2
- More frequent monitoring (potentially every 3 months) is warranted for higher-risk patients: those aged >50 years, taking hypertension or diabetes medications, or with baseline eGFR near threshold 1
- Critical pitfall: Do not continue TDF-based PrEP if creatinine clearance falls below 60 mL/min 1, 2
Annually
Hepatitis C Screening
- Perform hepatitis C serologic testing at least once yearly 1
- Increase frequency to every 6 months for high-risk individuals (people who inject drugs) or those with elevated transaminase levels 1, 2
Special Monitoring Situations
Initial 1-Month Visit
- Schedule a follow-up visit at 30 days after PrEP initiation to assess adherence, tolerability, and ensure absence of primary HIV infection 1, 2
If HIV Infection Occurs During PrEP
- Immediately add a boosted protease inhibitor (boosted darunavir) and/or dolutegravir to TDF/emtricitabine while awaiting HIV RNA and resistance testing results 1, 2
- Order resistance testing and establish linkage to HIV care 2
- Switch to a recommended initial antiretroviral treatment regimen once HIV is confirmed 2
Hepatitis B Co-infection
- Monitor liver function carefully after discontinuation of Truvada in patients with active hepatitis B, due to risk of acute hepatitis flares or hepatic decompensation 2
Common Pitfalls to Avoid
- Never prescribe >90-day supplies without documented negative HIV testing 1, 2
- Do not use TDF-based PrEP if creatinine clearance is <60 mL/min 1, 2
- Do not delay renal monitoring beyond 6 months in standard-risk patients or 3 months in high-risk patients 1, 2
- Do not assume condom use prevents all STIs—comprehensive anatomic site screening is essential 1, 2