Truvada PrEP Monitoring Requirements

Pre-Initiation Testing

The American College of Physicians and other medical societies recommend HIV testing with combination antigen-antibody assay before prescribing Truvada PrEP, with HIV RNA testing if acute HIV infection is suspected based on symptoms or recent high-risk exposure 1, 2
The Centers for Disease Control and Prevention recommend serum creatinine and calculated creatinine clearance using Cockcroft-Gault formula before starting Truvada PrEP, with a contraindication if creatinine clearance is <60 mL/min 1, 2, 3
The World Health Organization recommends hepatitis B surface antigen (HBsAg) testing and hepatitis C antibody testing before initiating Truvada PrEP 1, 2
The American College of Physicians recommends STI screening at all potentially exposed anatomic sites for gonorrhea, chlamydia, and syphilis before starting Truvada PrEP 4, 5
The Centers for Disease Control and Prevention recommend pregnancy testing for women of childbearing potential before initiating Truvada PrEP 3

The American College of Physicians recommends HIV testing with combination antigen-antibody assay every 3 months while on Truvada PrEP, with PrEP prescription not exceeding 90 days without interval HIV testing 1, 2, 3
The Centers for Disease Control and Prevention recommend STI screening at all exposed anatomic sites every 3 months for gonorrhea and chlamydia by nucleic acid amplification testing (NAAT), plus syphilis serology 1, 2, 4, 5
The World Health Organization recommends adherence assessment and counseling at every visit while on Truvada PrEP 2, 3, 5
The American College of Physicians recommends risk behavior assessment and provision of condoms every 3 months while on Truvada PrEP 3
The Centers for Disease Control and Prevention recommend pregnancy testing for women at each visit while on Truvada PrEP 3
The American College of Physicians recommends serum creatinine and estimated glomerular filtration rate (eGFR) calculation every 6 months while on Truvada PrEP 1, 2, 3, 4, 5
The World Health Organization recommends hepatitis C serologic testing at least annually, but every 6 months for high-risk individuals 2

The Centers for Disease Control and Prevention recommend careful monitoring of liver function after discontinuation of Truvada PrEP in patients with active hepatitis B, due to the risk of acute hepatitis flares or hepatic decompensation 1, 2
The American College of Physicians recommends a visit at 30 days after PrEP start to assess for adverse effects, perform follow-up HIV testing, and support adherence 2
The World Health Organization recommends immediately adding a boosted protease inhibitor and/or dolutegravir to TDF/FTC if HIV infection occurs during PrEP, while awaiting HIV RNA and resistance testing results 4, 5
The Centers for Disease Control and Prevention recommend ordering resistance testing and establishing linkage to HIV care if HIV infection occurs during PrEP 3
The American College of Physicians recommends switching to a recommended initial antiretroviral treatment regimen once HIV is confirmed 2

The American College of Physicians recommends not prescribing >90-day supplies of Truvada PrEP without documented negative HIV testing 1, 2
The Centers for Disease Control and Prevention recommend not using TDF-based PrEP if creatinine clearance is <60 mL/min, due to the risk of renal toxicity 1, 2, 6