Renal and Bone Over Time

HIV prevention with the long term in mind1-4

The duration of PrEP therapy can be unpredictable

Some patients take PrEP medications for extended periods of time, as their HIV risk persists.

In one study analyzing data from patients who received PrEP prescriptions at a Boston health center between 1/1/12 and 12/31/15, and who had ≥3 years of follow-up, almost half had an active prescription for >3 years*

Patterns of PrEP persistence (n=1402)

Chart showing patterns of PrEP persistence

*This study does not include DESCOVY FOR PrEP® users. DESCOVY® was approved for use in prevention in October 2019.

When prescribing a potential long-term drug, such as a PrEP medication, consider the following:

  • Kidney function may matter over time

  • Bone density is crucial for your patients of any age

Kidney function may decline over time due to age and other factors5-12

Age is one of the most common considerations, as eGFR may decline over time

Markers of renal function that can be affected by exposure to certain drugs include

  • eGFR
  • Serum creatinine

Mean GFR values across life span in males

Graph showing mean GFR values in males

Chart reprinted with permission from Elsevier.

Factors that may adversely affect kidney function include

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Behavioral
Excessive alcohol consumption

Anabolic steroid use

Use of stimulants
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Comorbidities
Hypertension

Obesity

Diabetes

CKD or declining renal function
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Other
Race/ethnicity

Family history

Use of OTC NSAIDs, dietary supplements, or other concomitant medications with renal AEsa
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Consider the long-term view when choosing a PrEP option, including impact on markers of kidney function.

Age and other factors may impact bone density9,13-15

Bone density develops through about age 30 and decreases as people age

  • Under 30: They may often still be building bone
  • Over 40: They may be naturally experiencing BMD declines

Bone mass across life span in males

Graph showing bone mass across lifespan in males

Chart adapted by permission from Springer Nature: Osteoporosis International. The national Osteoporosis Foundation's position statement on peak bone mass development and lifestyle factors: a systemic review and implementation recommendations, Weaver CM, Gordon CM, Jans KF, et al, 2016.

Additionally, BMD may be adversely affected by

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Behavioral factors
Smoking

Alcohol use

Methamphetamine use

Sedentary lifestyle

Suboptimal diet/Eating disorders
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Clinical factors
Dietary deficiencies (eg, calcium, vitamin C, D, K; manganese, etc)

Osteoporosis

Osteopenia

Lactose intolerance

Low BMI
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Concomitant medications
Corticosteroids

Antidepressants

Diabetes medications

Proton pump inhibitors
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Consider the importance of BMD when starting patients on a PrEP medication.

a Including psychotropic medications, ACEi/ARBs, certain antibiotics, and certain chemotherapies.
ACEi=angiotensin-converting enzyme inhibitor; AE=adverse event; ARB=angiotensin receptor blocker; BMD=bone mineral density; BMI=Body Mass Index; CKD=chronic kidney disease; eGFR=estimated glomerular filtration rate; NSAID=nonsteroidal anti-inflammatory drug; OTC=over the counter.