Reasons FOLX Might Not Be Able to Prescribe PrEP

There aren’t a ton of reasons why someone might not be able to take PrEP, but there are a few.

Pre-exposure prophylaxis (PrEP) is a medicine taken once a day to reduce the chances of getting HIV. The form of PrEP that FOLX offers is called emtricitabine/tenofovir disoproxil fumarate aka TDF/FTC, commonly known by the brand name Truvada. This medicine is safe for most people to take, however, there are some reasons you might not be able to take PrEP.

For the most part, you will know if one of these conditions applies to you! If you’re not sure, or have any additional questions about whether or not you can start PrEP with FOLX, you can reach out to our member advocate team at support@folxhealth.com.

FOLX is currently unable to prescribe PrEP if someone:

1. Is HIV positive.

Treatment for those living with HIV requires a different set of medications and tests that FOLX does not presently provide. The treatment for HIV is called antiretroviral therapy (ART), a combination of at least three HIV medicines taken every day. ART is recommended for everyone who has HIV. ART can't cure HIV, but the medications we have now mean that folx with HIV live healthy and long lives. Please see below for some additional resources that may help.

2. Has kidney disease and is on dialysis, or has stage 3-5 kidney disease/failure.

In order to be processed and passed out of the body TDF/FTC must go through a person’s kidneys. It is normal to see small decreases in kidney function that reverse after stopping PrEP. True kidney damage is uncommon.  This is why monitoring kidney tests is important particularly for have risk factors for kidney disease, such as high blood pressure and diabetes, or take other medications that can cause kidney problems, such as high doses of pain medications like ibuprofen and antiviral medications like acyclovir and famciclovir.

To help make sure it’s safe for you to take this medicine, the clinicians at FOLX check a test called creatinine. “Creatinine” is a waste product made by the body, and the kidneys filter creatinine from the blood. The amount of blood the kidneys can make creatinine-free each minute is called the creatinine clearance. If the kidneys are efficiently processing creatinine, then they will safely be able to handle TDF/FTC.

Descovy is a good PrEP option for those with stage 3 kidney failure. Find more information here on how to locate a Descovy provider near you.

3. Has osteoporosis, high risk of osteoporosis, or a history of pathologic fracture (broken bones without a known cause).

Osteoporosis is a condition where a person’s bones become weaker, which makes it easier for them to break. PrEP can also cause your bones to become less dense. Luckily, once someone stops taking PrEP, their bone density returns to what it was before they started the medication. Someone without osteoporosis doesn’t need to worry about PrEP affecting their bones. But, it’s dangerous for someone with osteoporosis to use a medication that weakens their bones, even if it’s temporary.

Descovy is a still a PrEP option for those with osteoporosis or at risk of having fractures. Find more information here on how to locate a Descovy provider near you.

4. Has an acute or chronic Hepatitis B infection.

Starting then stopping the PrEP with a hepatitis B infection can, in rare cases, lead to severe liver failure.  At FOLX, we check all of our members for Hepatitis B before we prescribe PrEP. FOLX is unfortunately unable to provide the additional oversight needed to manage and supervise additional liver testing in this instance.

Truvada and Descovy are still both good options for PrEP and treatment of Hepatitis B, but these medications require additional clinical support best suited by in-person care. Find more information here on how to locate a Descovy provider near you, or consult the GLMA Provider directory of LGBTQ-friendly providers.

5. Is under 18

Unfortunately we are not yet able to provide care to folx under 18. We’re working hard to make FOLX as accessible as possible across all ages. Pediatric care, aka care for those under 18, has different legal requirements, and we aren’t there just yet. Unfortunately this also includes those under 18 even with parent or guardian consent. Until you hit that exciting 18th birthday, we hope these resources can help:

  • The FOLX Health Library - Our free information resource covering the "What's Whats" and the "How-To's," across queer and trans healthcare questions from FOLX clinicians, team, and community.
  • GLMA Provider Directory - This searchable database of LGBTQ-friendly providers includes options to search for specific care for children and adolescents.
  • CDC PrEP Provider Data & Locator - A comprehensive, national directory of public and private providers in the U.S. that offer pre-exposure prophylaxis (PrEP) to prevent HIV infection. This database includes more than 1,800 PrEP providers from all 50 states, as well as U.S. territories.
  • CenterLink LGBTQ Center Finder - Locate LGBTQ centers and other LGBTQ organizations serving their local and regional communities. Also includes YouthLink which includes programming and support for newly forming youth centers and programs. 
  • GSA Network - Find local student-run organizations that unite LGBTQ+ and allied youth around the country.
  • GLSEN K-12 Advocacy - GLSEN works to ensure that LGBTQ students are able to learn and grow in a school environment free from bullying and harassment, and supports student organizers in schools across the country.

Gratefully, this list is relatively short! Some people are able to safely receive treatment closer to home while having one of these conditions, but at present, FOLX is unable to (which isn’t to say we don’t want to!). Learn more or sign up for PrEP with FOLX here. If you have any other questions, don't hesitate to reach out to support@folxhealth.com.