Background: The unmet need for PrEP has been exacerbated by the COVID-19 pandemic. While clinical trials have established the safety and efficacy of PrEP, the majority of participants were <45 years old. We aimed to better understand the unique considerations of use in this population through the assessment of real-world data in our cohort of Veterans ≥ 45 years old.

Setting and Methods: We reviewed all PrEP users, receiving any approved regimen at the Baltimore VA Medical Center in Maryland, USA between 12/3/2014 and 12/3/2019 and found n=59; of those, 18 (30.5%) were ≥ 45 years of age.

Results: There was no difference between baseline renal function and that ≥ 3 months post-PrEP initiation for all patients (creatinine (p=0.63), GFR (p=0.95), proteinuria (p=0.35)). Two patients switched from TDF to TAF due to rising creatinine. Both patients had comorbid hypertension and were on concomitant antiviral treatment, increasing the risk of nephrotoxicity; one patient had concomitant diabetes; neither had documentation of smoking, nor osteoporosis. Two others self-discontinued PrEP due to decreased risk behaviors or were lost to follow-up. Half (9/18) of patients had DEXA scans, with 4 (44.4%) indicating osteopenia, but all of these were noted prior to PrEP initiation and none had documented fractures either pre- or post-PrEP.

Conclusions: Our data suggests that TDF/FTC might be a safe and accessible option in this population. With increasing need for PrEP uptake, dedicated studies specific to this population should be conducted to further assess safety, efficacy, and tolerably of TDF/ FTC and TAF/FTC.