PrEP use can be long term1
A real-world study looked at ~14,000 people* who received PrEP care during a 6-year period1
(July 2012-March 2019; N=13,906)
Individuals engaged with PrEP care at any point during the retrospective study period1:
52.2% of those initiating PrEP discontinued at least once during the study
60.2% of those who discontinued reinitiated PrEP before the end of follow-up
(Hojilla JC, et al; 2021. Study used electronic health records from Integrated Health in Northern California)
*Prescriptions were filled for FTC/TDF or FTC/TAF for individuals aged ≥18 years with an indication for PrEP.1
PrEP was first approved by the FDA in 2012. DESCOVY FOR PrEP® was approved in October 2019.2
When prescribing a potential long-term medication, such as PrEP, consider that3:
- Renal function may change over time
- Bone density is crucial for individuals of any age
81%
of oral PrEP users had ≥1 renal or bone risk factor
in a retrospective study analyzing EHR data of over 40,000 people prescribed oral PrEP between 01/01/2015 and 02/29/2020.3
Renal
Renal function may change over time due to age and other factors3
Consider the age of PrEP users
Renal function may be declining after age 403
~40%
of men on a PrEP medication are aged 40 and over4†
†Source: IQVIA® LAAD Weekly, through April 2024.‡
‡This information is an estimate derived from the use of information under license from the following IQVIA information service: IQVIA LAAD Weekly data through April 2024. IQVIA expressly reserves all rights, including rights of copying, distribution and republication.4
Markers of renal function that can be affected by exposure to certain drugs include5:
- eGFR
- Serum creatinine
Renal risk factors may be more prevalent than you think: 62% of oral PrEP users had ≥1 renal risk factor.3
(Retrospective US observational study, January 2015-February 2020; N=40,621)
These are some of the risk factors that may impact renal function
Hypertension
According to the CDC, ~58% of Black men and ~50% of Latinx/o men aged 20 and over had hypertension from 2015-20186
(CDC, National Center for Health Statistics. Health, United States, 2019: Table 22)
According to the CDC, hypertension is the second leading cause of kidney failure. Men are at greater risk for CKD and ESRD than women7,8
(CDC; 2023. Weldegiorgis M and Woodward M; 2020; N=2,382,712)
Obesity
The obesity prevalence rate among MSM and MSMW was 23% and 27%, respectively, according to a 2022 meta-analysis of 43 studies9
(López Castillo H, et al; 2022)
Obesity is associated with a ~2x higher risk of developing chronic kidney disease, according to a 2021 systematic review and meta-analysis of prospective or retrospective cohort studies10
(Pinto KRD, et al; 2021)
NSAIDs
An estimated 1 in 4 Americans used NSAIDs regularly in a 2017 longitudinal analysis of National Health and Nutrition Examination Survey data from 1994-200411
(Davis JS, et al; 2017; N=13,744)
Taking ≥7 doses of NSAIDs per month can significantly increase the risk of kidney disease, according to a 2011-2014 cohort study of US Army soldiers12
(Nelson DA, et al; 2019; N=764,228)
Diabetes
According to the CDC, ~1 in 9 Black men and ~1 in 8 Latinx/o men were estimated to be diagnosed with diabetes in 202113
(CDC; 2021; 2019-2021 National Health Interview Survey)
According to the CDC, diabetes is the leading cause of kidney failure; ~1 in 3 adults with diabetes may have CKD7,14
(CDC; 2023. CDC; 2024)
Stimulant use
1 in 5 MSM (n=455) used illicit drugs, including cocaine and methamphetamines, in a 2017-2019 US cohort study of sexual minority men15
(Starks TJ, et al; 2020)
Stimulants, such as methamphetamines and cocaine, have been associated with a negative effect on kidney health16
(Fields SD and Tung E; 2021. Narrative review of patient-focused selection of PrEP medication for individuals at risk of HIV)
Smoking
Estimated prevalence of smoking cigarettes was ~45% higher in adult MSM than in other men in a 2021 meta-analysis of 30 studies published from 2007-202017
(Li J, et al; 2021; N=1,428,739)
Sampling period between 1999-2017.
Current and former smokers had significantly increased odds of chronic kidney disease compared with never smokers, according to a 2021 systematic review and meta-analysis of 104 studies from inception through June 201918
(Kelly JT, et al; 2021)
Additional risk factors7,19-23:
- Anabolic steroid use
- Excessive alcohol consumption
- Cocaine use
- Proton pump inhibitors
- Chronic kidney disease or declining renal function
- Comorbidities in adolescents
Resource
Renal Risk Factor Brochure
A resource with information about why renal function is an important consideration when prescribing PrEP medication. Includes risk factors that may impact renal function.
Bone
BMD may be a key consideration for individuals at any age24
People under 30 may still be building bone and have yet to reach peak BMD24,25
~26%
of men on a PrEP medication are aged 30 and under4†
†Source: IQVIA® LAAD Weekly, through April 2024.‡
‡This information is an estimate derived from the use of information under license from the following IQVIA information service: IQVIA LAAD Weekly data through April 2024. IQVIA expressly reserves all rights, including rights of copying, distribution and republication.4
Lifestyle factors influence 20% to 40% of adult peak bone mass, according to the National Osteoporosis Foundation.24
Bone risk factors may be more prevalent than you think: 68% of oral PrEP users had ≥1 bone risk factor.3
(Retrospective US observational study, January 2015-February 2020; N=40,621)
These are some of the risk factors that may impact bone mineral density
ADHD medications
MSM were ~60% more likely than other men to use prescription stimulants,* according to the 2015-2017 National Surveys on Drug Use and Health data of US adults aged 18 and older26
(Philbin MM, et al; 2020; n=58,815)
*Prescription stimulants included Adderall, Ritalin, dextroamphetamine, etc.
Stimulant ADHD medication usage was associated with a statistically significant decrease in BMD in the skull and spine,† according to DXA data from 2013-2018 NHANES of individuals aged 18 to 50 years27
ADHD medications reported in NHANES include amphetamine, methylphenidate, dextroamphetamine, amphetamine/dextroamphetamine, and lisdexamfetamine.
(Lawson MJ, et al; 2022; N=7961 [ADHD medication users, n=79; and controls, n=7871])
†No differences in BMD were seen in any other skeletal region.
Antidepressants
Sexual minority males were 2 to 3x more likely than other males to have had a past major depressive episode, according to results from the 2021 and 2022 National Surveys on Drug Use and Health28
(SAMHSA; 2023)
In a 2022 systematic review and meta-analysis, the use of SSRIs was associated with a decrease of BMD29
(Mercurio M, et al; 2022. The use of antidepressants is linked to bone loss: a systematic review and metanalysis)
Inhalant Use
MSM were 13x more likely to have used inhalants in the past year than other men,‡ according to the 2021 and 2022 National Surveys on Drug Use and Health28
(SAMHSA; 2023)
Low BMD was associated with the use of inhalants (eg, poppers) in MSM enrolled (n=210) at the San Francisco Department of Public Health site of the US CDC PrEP study from 2005 to 200730
(Liu AY, et al; 2011)
‡Calculated using weighted average of prevalence rates among sexual identity groups.
Proton pump inhibitors
~1 in 10 adults used a proton pump inhibitor (PPI), according to 2009-2013 data from the National Health and Nutrition Examination Survey31
(Devraj R and Deshpande M; 2020; n=18,504)
PPI use was associated with a 26% increased risk of hip fracture as compared to non-PPI users, according to a 2018 systematic review and observational meta-analysis of 17 case-controlled and cohort studies from inception to January 201832
(Hussain S, et al; 2018)
Vaping
>2 in 5 MSM (41%) smoked or vaped in the past 12 months, according to NHBS data among MSM in San Francisco (n=410) in 201433
(Santos GM, et al; 2019)
46% higher prevalence of self-reported fragility fractures§ among e-cigarette users¶ vs non-users, according to 2017-2018 NHANES data34
(Agoons DD, et al; 2021. Data on 5569 individuals aged >20 years. 1050 [18.8%] were past or present e-cigarette users)
§In hip, spine, or wrist.
¶Past or present users.
Excessive alcohol consumption
~41% of MSM (n=146) aged 18-25 showed a probable alcohol use disorder in a longitudinal cohort study of young adults in the US in 2003, 2005, 2007, and 201035
(Coulter R, et al; 2018)
Excessive alcohol intake could significantly increase the risk of osteoporosis-related fractures16
(Fields SD and Tung E; 2021. Narrative review of patient-focused selection of PrEP medication for individuals at risk of HIV)
Additional risk factors4,30,36-39:
- Methamphetamine use
- Smoking
- Opioid use
- Osteopenia/osteoporosis (younger males)
- Low BMD (TGW)
Resource
Bone Risk Factor Brochure
A resource with information about why BMD is an important consideration when prescribing PrEP medication. Includes risk factors that may impact BMD.
Renal function may change over time due to age and other factors3
Consider the age of PrEP users
Renal function may be declining after age 403
~40%
of men on a PrEP medication are aged 40 and over4†
†Source: IQVIA® LAAD Weekly, through April 2024.‡
‡This information is an estimate derived from the use of information under license from the following IQVIA information service: IQVIA LAAD Weekly data through April 2024. IQVIA expressly reserves all rights, including rights of copying, distribution and republication.4
Markers of renal function that can be affected by exposure to certain drugs include5:
- eGFR
- Serum creatinine
Renal risk factors may be more prevalent than you think: 62% of oral PrEP users had ≥1 renal risk factor.3
(Retrospective US observational study, January 2015-February 2020; N=40,621)
These are some of the risk factors that may impact renal function
Hypertension
According to the CDC, ~58% of Black men and ~50% of Latinx/o men aged 20 and over had hypertension from 2015-20186
(CDC, National Center for Health Statistics. Health, United States, 2019: Table 22)
According to the CDC, hypertension is the second leading cause of kidney failure. Men are at greater risk for CKD and ESRD than women7,8
(CDC; 2023. Weldegiorgis M and Woodward M; 2020; N=2,382,712)
Obesity
The obesity prevalence rate among MSM and MSMW was 23% and 27%, respectively, according to a 2022 meta-analysis of 43 studies9
(López Castillo H, et al; 2022)
Obesity is associated with a ~2x higher risk of developing chronic kidney disease, according to a 2021 systematic review and meta-analysis of prospective or retrospective cohort studies10
(Pinto KRD, et al; 2021)
NSAIDs
An estimated 1 in 4 Americans used NSAIDs regularly in a 2017 longitudinal analysis of National Health and Nutrition Examination Survey data from 1994-200411
(Davis JS, et al; 2017; N=13,744)
Taking ≥7 doses of NSAIDs per month can significantly increase the risk of kidney disease, according to a 2011-2014 cohort study of US Army soldiers12
(Nelson DA, et al; 2019; N=764,228)
Diabetes
According to the CDC, ~1 in 9 Black men and ~1 in 8 Latinx/o men were estimated to be diagnosed with diabetes in 202113
(CDC; 2021; 2019-2021 National Health Interview Survey)
According to the CDC, diabetes is the leading cause of kidney failure; ~1 in 3 adults with diabetes may have CKD7,14
(CDC; 2023. CDC; 2024)
Stimulant use
1 in 5 MSM (n=455) used illicit drugs, including cocaine and methamphetamines, in a 2017-2019 US cohort study of sexual minority men15
(Starks TJ, et al; 2020)
Stimulants, such as methamphetamines and cocaine, have been associated with a negative effect on kidney health16
(Fields SD and Tung E; 2021. Narrative review of patient-focused selection of PrEP medication for individuals at risk of HIV)
Smoking
Estimated prevalence of smoking cigarettes was ~45% higher in adult MSM than in other men in a 2021 meta-analysis of 30 studies published from 2007-202017
(Li J, et al; 2021; N=1,428,739)
Sampling period between 1999-2017.
Current and former smokers had significantly increased odds of chronic kidney disease compared with never smokers, according to a 2021 systematic review and meta-analysis of 104 studies from inception through June 201918
(Kelly JT, et al; 2021)
Additional risk factors7,19-23:
- Anabolic steroid use
- Excessive alcohol consumption
- Cocaine use
- Proton pump inhibitors
- Chronic kidney disease or declining renal function
- Comorbidities in adolescents
Resource
Renal Risk Factor Brochure
A resource with information about why renal function is an important consideration when prescribing PrEP medication. Includes risk factors that may impact renal function.
BMD may be a key consideration for individuals at any age24
People under 30 may still be building bone and have yet to reach peak BMD24,25
~26%
of men on a PrEP medication are aged 30 and under4†
†Source: IQVIA® LAAD Weekly, through April 2024.‡
‡This information is an estimate derived from the use of information under license from the following IQVIA information service: IQVIA LAAD Weekly data through April 2024. IQVIA expressly reserves all rights, including rights of copying, distribution and republication.4
Lifestyle factors influence 20% to 40% of adult peak bone mass, according to the National Osteoporosis Foundation.24
Bone risk factors may be more prevalent than you think: 68% of oral PrEP users had ≥1 bone risk factor.3
(Retrospective US observational study, January 2015-February 2020; N=40,621)
These are some of the risk factors that may impact bone mineral density
ADHD medications
MSM were ~60% more likely than other men to use prescription stimulants,* according to the 2015-2017 National Surveys on Drug Use and Health data of US adults aged 18 and older26
(Philbin MM, et al; 2020; n=58,815)
*Prescription stimulants included Adderall, Ritalin, dextroamphetamine, etc.
Stimulant ADHD medication usage was associated with a statistically significant decrease in BMD in the skull and spine,† according to DXA data from 2013-2018 NHANES of individuals aged 18 to 50 years27
ADHD medications reported in NHANES include amphetamine, methylphenidate, dextroamphetamine, amphetamine/dextroamphetamine, and lisdexamfetamine.
(Lawson MJ, et al; 2022; N=7961 [ADHD medication users, n=79; and controls, n=7871])
†No differences in BMD were seen in any other skeletal region.
Antidepressants
Sexual minority males were 2 to 3x more likely than other males to have had a past major depressive episode, according to results from the 2021 and 2022 National Surveys on Drug Use and Health28
(SAMHSA; 2023)
In a 2022 systematic review and meta-analysis, the use of SSRIs was associated with a decrease of BMD29
(Mercurio M, et al; 2022. The use of antidepressants is linked to bone loss: a systematic review and metanalysis)
Inhalant Use
MSM were 13x more likely to have used inhalants in the past year than other men,‡ according to the 2021 and 2022 National Surveys on Drug Use and Health28
(SAMHSA; 2023)
Low BMD was associated with the use of inhalants (eg, poppers) in MSM enrolled (n=210) at the San Francisco Department of Public Health site of the US CDC PrEP study from 2005 to 200730
(Liu AY, et al; 2011)
‡Calculated using weighted average of prevalence rates among sexual identity groups.
Proton pump inhibitors
~1 in 10 adults used a proton pump inhibitor (PPI), according to 2009-2013 data from the National Health and Nutrition Examination Survey31
(Devraj R and Deshpande M; 2020; n=18,504)
PPI use was associated with a 26% increased risk of hip fracture as compared to non-PPI users, according to a 2018 systematic review and observational meta-analysis of 17 case-controlled and cohort studies from inception to January 201832
(Hussain S, et al; 2018)
Vaping
>2 in 5 MSM (41%) smoked or vaped in the past 12 months, according to NHBS data among MSM in San Francisco (n=410) in 201433
(Santos GM, et al; 2019)
46% higher prevalence of self-reported fragility fractures§ among e-cigarette users¶ vs non-users, according to 2017-2018 NHANES data34
(Agoons DD, et al; 2021. Data on 5569 individuals aged >20 years. 1050 [18.8%] were past or present e-cigarette users)
§In hip, spine, or wrist.
¶Past or present users.
Excessive alcohol consumption
~41% of MSM (n=146) aged 18-25 showed a probable alcohol use disorder in a longitudinal cohort study of young adults in the US in 2003, 2005, 2007, and 201035
(Coulter R, et al; 2018)
Excessive alcohol intake could significantly increase the risk of osteoporosis-related fractures16
(Fields SD and Tung E; 2021. Narrative review of patient-focused selection of PrEP medication for individuals at risk of HIV)
Additional risk factors4,30,36-39:
- Methamphetamine use
- Smoking
- Opioid use
- Osteopenia/osteoporosis (younger males)
- Low BMD (TGW)
Resource
Bone Risk Factor Brochure
A resource with information about why BMD is an important consideration when prescribing PrEP medication. Includes risk factors that may impact BMD.
Consider the long-term view when choosing a PrEP option, including impact on markers of renal function and BMD.
ADHD=attention-deficit/hyperactivity disorder; BMD=bone mineral density; CDC=Centers for Disease Control and Prevention; CKD=chronic kidney disease; DXA=dual-energy X-ray absorptiometry; eGFR=estimated glomerular filtration rate; EHR=electronic health record; ESRD=end-stage renal disease; FTC/TAF=emtricitabine/tenofovir alafenamide fumarate; FTC/TDF=emtricitabine/tenofovir disoproxil fumarate; IQVIA=IMS Health, Quintiles, and VIA; LAAD=Longitudinal Access and Adjudication Data; MSM=men who have sex with men; MSMW=men who have sex with men and women; NHANES=National Health and Nutrition Examination Survey; NHBS=National HIV Behavioral Surveillance; NSAID=nonsteroidal anti-inflammatory drug; PPI=proton pump inhibitor; SAMHSA=Substance Abuse and Mental Health Services Administration; SSRI=selective serotonin reuptake inhibitor (SSRI is one class of drugs used to treat depression); TGW=transgender women (who have sex with men).
Now that you’ve learned about some of the risk factors that can impact renal function and BMD over time, there’s more to explore with DESCOVY.
Select a topic:
See the difference between tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF), 2 key PrEP medication components.
