What questions should be asked during a prep consultation for a patient with a history of chronic conditions, such as diabetes (Diabetes Mellitus), hypertension (Hypertension), or heart disease (Cardiovascular Disease), who is taking various medications and supplements, and has lifestyle habits including smoking or alcohol use, to ensure they are adequately prepared for an upcoming medical procedure?

PrEP Consultation: Essential Questions to Ask

During a PrEP consultation, systematically assess HIV risk factors, sexual health history, baseline medical conditions (especially renal and hepatic function), current medications, and contraindications to ensure safe initiation of pre-exposure prophylaxis.

Sexual Health and HIV Risk Assessment

• Ask about sexual practices and partners: Document number of sexual partners, types of sexual activity (anal, vaginal), condom use frequency, and whether partners are of unknown HIV status or known HIV-positive 1

• Screen for sexually transmitted infections (STIs): Inquire about history of gonorrhea, chlamydia, syphilis, and other STIs, as these indicate higher HIV acquisition risk and require baseline screening 1

• Assess partner HIV status and viral load: Determine if any sexual partners are HIV-positive and whether they are virally suppressed on antiretroviral therapy 1

• Document injection drug use: Ask specifically about sharing needles or injection equipment, as this represents a distinct HIV transmission risk 1

Medical History and Chronic Conditions

• Evaluate renal function history: Ask about pre-existing kidney disease, diabetes mellitus, hypertension, or any conditions affecting renal function, as PrEP medications (tenofovir-based regimens) require adequate kidney function 1

• Screen for hepatitis B infection: Document hepatitis B vaccination status and any history of hepatitis B, as discontinuing tenofovir-based PrEP in hepatitis B co-infected patients can cause severe hepatitis flares 1

• Assess for bone health risk factors: Inquire about osteoporosis, previous fractures, steroid use, or other risk factors for bone density loss, particularly relevant for tenofovir disoproxil fumarate (TDF) 1

• Document cardiovascular risk factors: Record history of hypertension, diabetes, peripheral vascular disease, coronary artery disease, and stroke, as these affect overall health management 1

Medication Review and Drug Interactions

• Review all current medications with exact dosages: Document prescription medications, over-the-counter drugs, herbal supplements, and nutritional supplements, as drug interactions can affect PrEP efficacy or increase toxicity 1

• Identify nephrotoxic medications: Specifically ask about NSAIDs, aminoglycosides, or other medications that could compound renal toxicity risk when combined with tenofovir 1

• Screen for antiretroviral medications: Ensure the patient is not already taking HIV treatment medications, which would indicate possible undiagnosed HIV infection 1

Substance Use and Lifestyle Factors

• Document alcohol consumption patterns: Use structured screening tools (CAGE questionnaire: Cut down, Annoyed, Guilty, Eye-opener) to assess alcohol use, as heavy drinking affects medication adherence and liver function 1

• Assess tobacco use: Record current smoking status and pack-years, using the "5 A's" approach (Ask, Advise, Assess, Assist, Arrange) for smoking cessation 1

• Screen for recreational drug use: Ask about methamphetamine, cocaine, poppers (amyl nitrite), and other substances associated with high-risk sexual behavior 1

Reproductive Health and Pregnancy Planning

• Assess pregnancy intentions and contraception: For patients who can become pregnant, document reproductive life plan and current contraceptive methods, as PrEP safety data in pregnancy varies by regimen 1

• Screen for current pregnancy: Confirm pregnancy status before initiating PrEP, particularly for tenofovir alafenamide (TAF) which has limited pregnancy data 1

Functional Capacity and Adherence Assessment

• Evaluate ability to adhere to daily medication: Ask about current medication adherence patterns, daily routine stability, housing security, and factors that might affect taking daily pills 1, 2

• Assess social support and barriers: Document social determinants of health including food security, housing stability, transportation access, and financial resources that could impact PrEP adherence 2

• Screen for mental health conditions: Ask about depression, anxiety, and other psychiatric conditions that may affect adherence or require medication management 1

Baseline Laboratory Planning

• Confirm HIV-negative status: Document timing of last HIV test and plan for baseline HIV testing before PrEP initiation 1

• Establish baseline renal function: Plan for serum creatinine and estimated glomerular filtration rate (eGFR) measurement, as creatinine clearance <60 mL/min requires dose adjustment or alternative regimens 1

• Screen for hepatitis B and C: Document need for hepatitis B surface antigen, surface antibody, and core antibody testing, plus hepatitis C antibody 1

Critical Pitfalls to Avoid

• Never assume low risk based on relationship status alone: Patients in monogamous relationships may still have partners with undisclosed HIV risk factors or unknown status 1

• Don't overlook transgender-specific considerations: Ask about gender-affirming hormone therapy, as some formulations may interact with PrEP medications 1

• Avoid judgmental language about sexual practices: Use neutral, clinical terminology to maintain trust and ensure accurate risk assessment 1

• Don't forget to assess health insurance and cost barriers: PrEP access depends on insurance coverage, patient assistance programs, and out-of-pocket costs that affect long-term adherence 2