PrEP Eligibility and Renal Function Assessment

Introduction to PrEP Eligibility

• The International Antiviral Society-USA Panel recommends that TDF-based PrEP is contraindicated when creatinine clearance falls below 60 mL/min/1.73 m², with an evidence rating of AIIa 1, 2, 3

Calculating Creatinine Clearance

• The American College of Physicians suggests calculating creatinine clearance using the Cockcroft-Gault equation or measuring eGFR before making any PrEP prescribing decision 1, 2

Absolute Contraindication Threshold

• TDF-based PrEP is not recommended for persons with creatinine clearance below 60 mL/min/1.73 m², according to the International Antiviral Society-USA Panel 1, 2, 3

Alternative PrEP Options for Renal Dysfunction

• For men who have sex with men with CrCl 60-89 mL/min or other renal risk factors, the Centers for Disease Control and Prevention suggests considering tenofovir alafenamide/emtricitabine instead of TDF/FTC 4

Monitoring Frequency

• The International Antiviral Society-USA Panel recommends standard monitoring with creatinine measurement every 6 months for low-risk patients, and enhanced monitoring every 3 months or more for patients with renal risk factors 1, 2, 3

Hepatitis B Considerations

• The American Association for the Study of Liver Diseases recommends measuring hepatitis B surface antigen before PrEP initiation, and using TDF/emtricitabine regimens for HBV-positive patients 3, 7