PrEP And Kidney Disease

[+ Gar1eth]

I have mild chronic renal disease. My creatinine clearance is 56 with low end of normal being 60 or greater. 
 

We probably all know that Descovy is supposed to have a better safety profile than Truvada as regards the kidney. But the question I'm pondering since I don't have sex that often is -would it be better to do the 2-1-1 Prep on Demand with Truvada (which is worse for the kidneys) since I don't need it that often or just take daily Descovy. 
 

What I'm looking for is not laymen's opinions,  but if anyone has had similar discussions with their doctor.  
  
Thanks

[Rudynate]

Yes, I had the same conversation with my provider.  I have early stage III CKD, but as long as I mind my P's and Q's, my GFR stays above 60.  My Prep nurse got rather pushy about switching to Descovy.  I'm with Kaiser, so my only expense would be a co-pay.  The upshot of the conversation was that I realized I was tired of messing with PREP, so I stopped the Truvada and didn't start Descovy.

[+ Gar1eth]

16 hours ago, Rudynate said:

Yes, I had the same conversation with my provider.  I have early stage III CKD, but as long as I mind my P's and Q's, my GFR stays above 60.  My Prep nurse got rather pushy about switching to Descovy.  I'm with Kaiser, so my only expense would be a co-pay.  The upshot of the conversation was that I realized I was tired of messing with PREP, so I stopped the Truvada and didn't start Descovy.

It's difficult for me to keep an erection if bare-much less in a condom (sorry if that's TMI). So I really would prefer being on PrEP (I just saw the urologist -they are willing to cautiously let me try testosterone even though I have a funny area on my prostate by MRI-assuming of course the cardiologist agrees). So maybe the testosterone will help.
 

But I thought with the Affordable Care Act most PrEP medications were supposed to be covered without a copay. In fact I just read that tonight. 

Edited June 19 by Gar1eth
Corrected spelling

[Rudynate]

Maybe so.   I  don't remember what my co-pay for Truvada was.  When I found that I could get a generic for Truvada offshore for a small fraction of the US cost of Truvada, I started doing that.

[+ Gar1eth]

3 hours ago, Rudynate said:

Maybe so.   I  don't remember what my co-pay for Truvada was.  When I found that I could get a generic for Truvada offshore for a small fraction of the US cost of Truvada, I started doing that.

If you ever decide to restart genetic Truvada  and don't want to use insurance, I found these local prices on Goodrx 

 

Edited June 19 by Gar1eth

[MikeBiDude]

29 minutes ago, Gar1eth said:

If you ever decide to restart genetic Truvada  and don't want to use insurance, I found these local prices on Goodrx 

 

Amazon pharmacy is getting me the generic at $15.79/month, auto refill, they contact my physician. All automatic.

[Danny-Darko]

13 hours ago, Gar1eth said:

It's difficult for me to keep an erection if bare-much less in a condom (sorry if that's TMI). So I really would prefer being on PrEP (I just saw the urologist -they are willing to cautiously let me try testosterone even though I have a funny area on my prostate by MRI-assuming of course the cardiologist agrees). So maybe the testosterone will help.
 

But I thought with the Affordable Care Act most PrEP medications were supposed to be covered without a copay. In fact I just read that tonight. 

I understand you. Do you take Saw Palmetto supplements? I have been taking it for years now daily per advice from my urologist. And while it's not a miracle cure, it does help together with my regular prostate medication for both my prostate and ED. 

[+ Gar1eth]

8 minutes ago, Danny-Darko said:

I understand you. Do you take Saw Palmetto supplements? I have been taking it for years now daily per advice from my urologist. And while it's not a miracle cure, it does help together with my regular prostate medication for both my prostate and ED. 

I've heard about it. But never taken it. I'll talk the urology PA when I see him. A doctor also told me once about milk thistle. I'm supposed to have a 'bedside' cystoscopy when I see him. We'll see if I can do it. I'm squeamish about being penetrated-ANYWHERE!!!

[Danny-Darko]

6 minutes ago, Gar1eth said:

I've heard about it. But never taken it. I'll talk the urology PA when I see him. A doctor also told me once about milk thistle. I'm supposed to have a 'bedside' cystoscopy when I see him. We'll see if I can do it. I'm squeamish about being penetrated-ANYWHERE!!!

I agree! I as well have issues with that in the past and my urologist knows that I have to be put under with anestesia (not just topical) to have anything done in there! As long as he approves it and orders it, the insurance has never said no, and they keep in me in observation when I recover from anestesia till I'm able to go home too. I do have to sign a few quick papers saying I understand that my doctor has ordered it and never once had a problem with insurance or the hospital and it's been several times now. Good luck! 

[Rudynate]

55 minutes ago, MikeBiDude said:

Amazon pharmacy is getting me the generic at $15.79/month, auto refill, they contact my physician. All automatic.

Thanks very much.  Now that Truvada is generic in the US, there's no reason to bother with the offshore route.  I took it long enough ago that I think my copay for 90 days was $300 or so.

[GentSociety]

On 6/18/2025 at 8:22 PM, Gar1eth said:

I have mild chronic renal disease. My creatinine clearance is 56 with low end of normal being 60 or greater. 
 

We probably all know that Descovy is supposed to have a better safety profile than Truvada as regards the kidney. But the question I'm pondering since I don't have sex that often is -would it be better to do the 2-1-1 Prep on Demand with Truvada (which is worse for the kidneys) since I don't need it that often or just take daily Descovy. 
 

What I'm looking for is not laymen's opinions,  but if anyone has had similar discussions with their doctor.  
  
Thanks

I would recommend Truvada is you are not sexually active.