PrEP Special Situations that may Arise for Clients
Being adolescents
and young adults
(< age 25)
• May benefit from:
– more frequent visits, including telephone calls with
providers
– flexible clinic schedules
– access to additional services
• Careful attention to staff interactions with clients is important
to ensure providers are non-judgmental and approachable
Being pregnant
and/or breastfeeding
• Are at increased risk for acquiring HIV
• May require special counselling on their risk for HIV and
benefits of PrEP, which poses no safety risk to this population
Using hormonal
contraception
• Can take PrEP medications, as they do not interact with
contraceptives, whether the contraceptive is oral, injectable, or
transplanted
• Can simultaneously use PrEP and hormonal contraceptives
safely and effectively
Developing elevated
serum creatinine
while using PrEP
• Some clients may have kidneys unable to sufficiently process
PrEP and eliminate creatinine from the blood through urine
• Should have a second creatinine test
• Should stop PrEP if second test result shows elevated serum
creatinine or creatinine clearance <60 mL/min
Having hepatitis B
• May experience a flare after stopping TDF, even 1–3 months
later
• Should consider ALT and AST tests before starting PrEP
Seroconverting after
starting PrEP
• May have already been infected with HIV before starting PrEP
but not infected long enough to test seropositive for HIV
• May not have used PrEP consistently or at all after being
given PrEP
Injecting or using
recreational drugs
• Should use harm reduction services if relevant and available
• Should be considered for PrEP if at high risk of sexually
acquiring HIV