Emtricitabine/tenofovir disoproxil tablets

Pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate plus emtricitabine has been proven to be a highly effective means of HIV prevention in randomised clinical trials (RCTs), with reported efficacy in preventing HIV infection of up to 92% (among patients with a detectable drug concentration) in iPrEx⁴, 86% in PROUD⁵  and 86% in IPERGAY^6,7. PrEP efficacy is strongly associated with adherence. The open label extension of the iPrEx study showed no HIV seroconversions in those taking ≥4 pills per week⁸. 

RCTs have shown good safety data (including renal safety data) for daily and on-demand oral TDF-FTC as PrEP. Where renal function has been affected, TDF-FTC was associated with mild, non-progressive and reversible reductions in creatinine clearance (CrCl)². 

TD/FTC became available through the NHS in Scotland in July 2017 and is approved for all populations at risk of HIV.

• Counsel all individuals who would benefit from a reduction in HIV risk about the availability of PrEP. 

• Behaviour, reporting and understanding of risk change over time. Therefore, consideration of risk and benefit over time is as important as at the time of initiation. 

• PrEP should be prescribed for people in whom it is suitable as soon as HIV risk is identified as benefit is immediate and toxicity is uncommon and delayed. 

• Individuals with risk factors or who have chronic renal disease should be advised of the possibility of reduced renal function and the required frequency of renal monitoring.