Clinical follow-up and monitoring of patients on PrEP
Renal function should be monitored at 3 months and 6 monthly thereafter, or more frequently in certain populations (see Assessment of renal function at baseline). The management of people with high and ongoing risk of HIV infection, but whose eGFR has declined below or around 60 mL/min/1.73 m2 since commencing TD*/FTC, is challenging. This situation typically requires consultation with a physician who is expert in PrEP. Cessation of TD*/FTC for 1 month may restore eGFR to above 60 mL/min/1.73 m2, following which TD*/FTC may be recommenced with cautious monitoring. In these circumstances, consideration should be given to using on-demand† TD*/FTC, or possibly second-daily TD*/FTC. However, there are no data to show that either of these options will stabilise the eGFR above 60 mL/min/1.73 m2.
† The Therapeutic Goods Administration (TGA) has not approved this regimen in Australia.