title: A case study of chewed Truvada®for PrEP maintaining protective drug levels as measured by a novel urine tenofovir assay.
abstract: Emtricitabine/tenofovir disoproxil fumarate (FTC/TDF; Truvada®) given as pre-exposure prophylaxis (PrEP) successfully blocks HIV when taken once daily prior to potential HIV exposure. A 22-year-old male reported difficulty swallowing FTC/TDF for PrEP and subsequently began chewing the FTC/TDF tablets. Monthly urine samples assessed using liquid chromatography-tandem mass spectrometry (LC-MS/MS) indicated tenofovir levels >1,000 ng/ml, indicative of protection from HIV acquisition, over a 48-week period. Data from observational studies of HIV-positive patients details the successful treatment of HIV using crushed FTC/TDF delivered via feeding and gastronomy tubes while small, randomized trials of healthy volunteers demonstrate bioequivalence between whole and crushed FTC/TDF.
authors.affiliation: Philadelphia FIGHT Community Health Centers, Philadelphia, PA, USA.
authors.forename: Linden
authors.initials: L
authors.lastname: Lalley-Chareczko
authors.affiliation: Philadelphia FIGHT Community Health Centers, Philadelphia, PA, USA.
authors.forename: Devon
authors.initials: D
authors.lastname: Clark
authors.affiliation: Division of Pediatric Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Athena F
authors.initials: AF
authors.lastname: Zuppa
authors.affiliation: Division of Clinical Pharmacology & Therapeutics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Moorthy
authors.affiliation: Philadelphia FIGHT Community Health Centers, Philadelphia, PA, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Conyngham
authors.affiliation: Philadelphia FIGHT Community Health Centers, Philadelphia, PA, USA.
authors.forename: Karam
authors.initials: K
authors.lastname: Mounzer
authors.affiliation: Philadelphia FIGHT Community Health Centers, Philadelphia, PA, USA.|Division of Infectious Diseases, MacGregor Infectious Diseases Clinic, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Koenig
mesh_terms: D019380:Anti-HIV Agents / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D002853:Chromatography, Liquid; D016903:Drug Monitoring; D000069480:Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control*; D006801:Humans; D008297:Male; D065129:Pre-Exposure Prophylaxis; D053719:Tandem Mass Spectrometry; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D000069480:Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination