Disclaimer: I do not have any recent exposure, or suspected exposure to HIV. I’m asking this as a general/academic question.
We know that if a person is taking tenofovir + emtricitabine (Truvada or Descovy), the risk of HIV infection would be very low, but what if they’re not taking one of those combined pills, and they’re just taking Viread or Vemlidy on its own? It seems like there’s a possibility this might reduce risk of transmission, though not as much as Truvada or Descovy. It also seems risky, because if it’s not enough to prevent HIV infection, and the patient continues to take their hep B medication, this could lead to the HIV developing resistance to tenofovir before the patient even realizes that they have HIV. Then, when they go to start treatment for HIV, there would potentially be a lot fewer options available.
I’m curious – how do clinicians handle this situation in the real world? We know that there is a sizable patient population infected with both hep B and HIV. Obviously, if we identify that people are high-risk for exposure to HIV, we would prescribe PrEP in the first place, but the reality is that determining who is at risk and who is not is a hard problem, and it’s something that we are not very good at, which is why universal screening is recommended.