title: Safety of oral tenofovir disoproxil fumarate-based pre-exposure prophylaxis for HIV prevention.
abstract: BACKGROUND
  Tenofovir disoproxil fumarate (TDF)-based pre-exposure prophylaxis is a novel HIV prevention strategy for individuals at increased sexual risk for HIV infection. For any biomedical prevention intervention, the bar for tolerating adverse effects in healthy persons is high compared to therapeutic interventions.
  
  
  METHODS
  We provide a concise summary of the clinical safety of TDF-based pre-exposure prophylaxis with focus on TDF-related effects on tolerability, kidney function, bone density, HIV resistance, sexual and reproductive health. The evidence base for this review is derived from a literature search of both randomized and observational studies evaluating efficacy and safety of TDF-based PrEP, TDF alone or in combination with emtricitabine, identified from PUBMED and EMBASE electronic databases, clinicaltrials.gov and major HIV conferences.
  
  
  CONCLUSIONS
  TDF-based pre-exposure prophylaxis is a potent intervention against HIV acquisition when taken which is generally safe and well tolerated. The risk of the small, non-progressive, and reversible decline in glomerular filtration rate and bone mineral density as well as the potential selection for drug resistance associated with PrEP are outweighed, at the population level and broadly for individuals, by PrEP's substantial reduction in the risk of HIV infection.
authors.affiliation: a Department of Epidemiology , University of Washington , Seattle , WA , USA.|b Department of Global Health , University of Washington , Seattle , WA , USA.|c Division of Disease Control, School of Public Health , Makerere University , Kampala , Uganda.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Mugwanya
authors.affiliation: a Department of Epidemiology , University of Washington , Seattle , WA , USA.|b Department of Global Health , University of Washington , Seattle , WA , USA.|d Department of Medicine , University of Washington , Seattle , WA , USA.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
mesh_terms: D000284:Administration, Oral; D000818:Animals; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000068679:Emtricitabine / Q000008:administration & dosage; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D065129:Pre-Exposure Prophylaxis / Q000379:methods; D012306:Risk; D000068698:Tenofovir / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D000068698:Tenofovir; D000068679:Emtricitabine
keywords: HIV prevention; PrEP; Safety of PrEP; TDF; Tenofovir disoproxil fumarate; pre-exposure prophylaxis