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Patients taking PrEP should be assessed for side-effects associated with TD*/FTC use, most importantly those suggesting possible acute renal injury. A review of symptoms experienced in the iPrEx (Iniciativa Profilaxis Pre-Exposición) study showed that potential PrEP-associated symptoms peaked at 1 month, when 39% of participants reported symptoms, compared with 22% at baseline. Gastrointestinal (GI) symptoms occurred in a median of 28% of participants across study sites (range 11–70%) and non-GI symptoms occurred in a median of 24% of participants (range 3–59%). The odds of GI symptoms were higher in those with evidence of high adherence to PrEP. By 3 months, symptoms had returned to pre-PrEP levels (14).

Bodybuilding increases muscle mass, which may result in increased creatinine levels in blood. When evaluating and managing PrEP users with creatinine clearance changes, clinicians should take into consideration the history of steroid, protein, creatine powder use (which also increases blood creatinine levels) and bodybuilding. A wash-out period of 14 days cessation of creatine before renal function assessment may be recommended.

The ASHM PrEP Guidelines Panel will monitor evidence in this area and update the guidelines as appropriate.