A Darrell Lyons is a 46 year-old Hispanic man presents to your clinic for is annual physical exam. He is in a non-monogamous relationship with a 30 year-old man with an unknown HIV status. He has had 2 other sexual partners in the past 4 months. He is uns

A Darrell Lyons is a 46 year-old Hispanic man presents to your clinic for is annual physical exam. He is in a non-monogamous relationship with a 30 year-old man with an unknown HIV status. He has had 2 other sexual partners in the past 4 months. He is unsure of their HIV status as well. He tells you that he doesn’t use condoms consistently when he is top or bottom during anal sex. He has a history of HTN, seizure disorder and CKD (last CrCl=45). He is interested in starting PrEP. You say,

A) “Mr. Lyons, you seem to engage in a few high-risk sex practices. I’ll start you on PrEP today! Horray!”

B) “Mr. Lyons, you seem to engage in a few high-risk sex practices. Unfortunately, your CKD with CrCl is a contraindication for starting Truvada (tenofivir/emtricitabine). I’m so sorry!”

C) “Mr. Lyons, I’m glad you’re here and invested in your health. Unfortunately at this time, your CKD is a contraindication for starting Truvada (tenofivir/emtricitabine), since your CrCl is less than 60. However, I wonder if you’d be comfortable having a longer conversation about what’s happening in your sex life. There are still many ways to decrease your risk, and in fact, the first step would be to screen you for all STDs, including HIV. ”

D) “My. Lyons, I wasn’t listening to Marlon when he was droning on about PrEP 2 days ago cause he’s a bore. Excuse me while I have a nap on this big, fluffy, wooden desk.”

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