Renal impairment: an unnecessary barrier to HIV prevention
Jack E. Heron
A D , Suzanne Rix B , Rick Varma B and David M. Gracey A C
A Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
B Sydney Sexual Health Centre, South Eastern Sydney Local Health District, Sydney, NSW 2000, Australia.
C Central Clinical School, The University of Sydney, Sydney, NSW 2006, Australia.
D Corresponding author. Email: Jack.Heron@health.nsw.gov.au
Sexual Health 17(3) 299-300 https://doi.org/10.1071/SH20037
Submitted: 9 March 2020 Accepted: 21 April 2020 Published: 24 June 2020
Abstract
The use of tenofovir disoproxil fumarate (TDF) in combination with emtricitabine, prescribed for pre-exposure prophylaxis (PrEP), is highly effective at reducing incident sexually transmissible HIV infection among those at risk. TDF is associated with proteinuria, Fanconi syndrome and chronic kidney disease, and is not recommended for use in patients with an estimated creatinine clearance <60 mL min−1. There are currently no Pharmaceutical Benefits Scheme (PBS)-funded PrEP options for patients at risk of HIV infection with moderate renal impairment in Australia. This report describes the case of a patient who acquired HIV soon after PrEP was suspended due to moderate renal impairment. The various clinical and regulatory issues this case raises are discussed.
Additional keywords: antiretrovirals, HIV/AIDS.
References
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