Complex case MDT - PrEP intolerance - Conflict of Interest & GI Side Effects

Sep 27, 2026

Uploaded by Asher

Meeting presentation content addresses PrEP intolerance in clinical practice, including a case-based discussion of gastrointestinal (GI) side effects that are non-transient for some users. It summarizes background evidence on TDF/TAF/FTC tolerability, trends in PrEP users and people living with HIV, and highlights data from PrEP trials and national MDT referrals. Management guidance covers adherence, dosing strategies, and supportive pharmacology, followed by options for an individual case when nausea and vomiting occur after EBD.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages66

Reading Time2 h 46 min

AccessFree to download

Background

Data from PrEP trials

Incidence of GI adverse effects

Data from national PrEP MDT

Why do GI SEs occur?

Common management tips

Case study

Eric (28yo MSM)

Options

Complex case MDT Chairs: Nicola Mackie She/her, Imperial College Healthcare NHS Trust Moses Shongwe He/him, Barts Health NHS Trust PrEP intolerance Hasan Mirza He/him PrEP & Sexual Health Pharmacist Barts Health NHS Trust, London “I can’t have sex when I don’t take PrEP but I can’t have sex when I do take PrEP as taking PrEP makes it impossible to have sex .” Hasan Mirza PrEP & Sexual Health Pharmacist Barts Health NHS Trust, London Conflict of Interest I have no conflicts of interest Speakers are required by the Federation of the Royal Colleges of Physicians to disclose conflicts of interest at the beginning of their presentation, with sufficient time for the information to be read by the audience. They should disclose financial relationships with manufacturers of any commercial product and/or providers of commercial services used on or produced for patients relating to the 36 months prior to the event. These include speaker fees, research grants, fees for other educational activities such as training of health professionals and consultation fees. Where a speaker owns shares or stocks directly in a company producing products or services for healthcare this should also be declared. Background 􀁘 TDF or TAF/FTC is a well tolerated medication amongst PrEP users and people living with HIV (PLWH) 􀁘 Number of PrEP users is growing: 96,000 (+12%, England, 2023) 􀁘 PLWH accessing care: 100,000 (+6%, England, 2022) 􀁘 Despite 20 years of experience with TDF/FTC, a lack of alternative PrEP options means new clinical conundrums are emerging 􀁘 There is a small but significant proportion of PrEP users who report intolerable GI side effects which are non-transient Data from PrEP trials | Trial | Incidence of GI SEs | ADR related discontinuations | | --- | --- | --- | | PROUD (n=544) | - | 21/275 (8%)– 5/21 GI related (1 .8%) | | IPERGAY (n=400) | 14%(vs 5% placebo) | nil | | iPrEX OLE (n=1225) | 14% | Nausea/abdo pain 0.9%; diarrhoea 0.4%
Inverse association between GI SEs and adherence | 􀁘 Most common: nausea > abdo pain > flatulence > diarrhoea > vomiting 􀁘 GI SEs are common but rarely lead to discontinuation 􀁘 PrEP persistence may be higher amongst trial participants – threshold for stopping? Data from national PrEP MDT 􀁘 Of 258 national PrEP MDT referrals 1 , 12%(32/258) related to non-renal/bone side effects 􀁘 Amongst Descovy PrEP users at CWFT (n=170), 4%(7/170) were switched from TDF PrEP due to GI side effects 􀁘 There was one GI-related TAF discontinuation (0.6%)2 1. BASHH Conference 2024. O19: Complex PrEP: Outcomes from a Complex PrEP referral service. Olivia Harden 2. BASHH Conference 2024. P65: When One Size Doesn’t Fit All -Service Evaluation Reviewing Second Line F/TAF PrEP Use. Yaser Al-Shakarchi Why do GI SEs occur? 􀁘 For many drugs, including PrEP, exact mechanism is unknown Common management tips: 􀁘 Perseverance 􀁘 Take meds with food 􀁘 Take at night to ‘sleep through’nausea 􀁘 Anti-emetic/anti-diarrhoeal/PPI But what if we try all that? Causes of GISEs Case study 􀁘 Eric, 28yo MSM 􀁘 PrEP need: condomless anal sex (approx . 5 CMPs in last 6/12) 􀁘 PMH: nil 􀁘 eGFR >90, Hep B immune 􀁘 Co-meds: nil 􀁘 Allergies: lactose intolerant, NKDA 􀁘 Seen in clinic and commenced on PrEP, plans to use EBD 􀁘 Returns 1mth later and reports n+v following EBD. Tried daily for 1/52 but experienced ongoing nausea and mild diarrhoea . Has not been sexually active 􀁘 Asks about alternate PrEP options? Options 􀁘 A) Switch to Descovy PrEP 􀁘 B) Refer for compassionate use IM cabotegravir 􀁘 C) Prescribe anti-emetic and try again 􀁘 D) Something else?

FAQs

What is the focus of the presentation on PrEP intolerance?

It focuses on PrEP intolerance, particularly non-transient gastrointestinal side effects reported by a subset of PrEP users.

What do the trial data suggest about GI side effects and discontinuation?

GI adverse effects are common across trials but rarely lead to discontinuation, with rates varying by study and outcomes noting factors like adherence.

What options are considered when a patient has ongoing nausea and mild diarrhoea after EBD?

The case discusses options such as switching to Descovy PrEP, referring for compassionate use with IM cabotegravir, or prescribing anti-emetic therapy and retrying, alongside exploring other possibilities.

Sep 27, 2026

Uploaded by Asher