The risk of kidney damage with PrEP is just as low as with most other HIV medications. The trouble isn't in the short term, it's in the long term. If you have HIV you have no choice but to take your medication. If you're taking it as a prophylaxis then you can stop any time your kidneys start to show trouble.
One of my mates has HIV and has lost one of his kidneys to the meds.
He was on Truvada + some other stuff. It was the Truvada that killed his kidney. Truvada is the medication they prescribe for PrEP as it's the only one that has the research behind it towards its efficacy. Descovy is still undergoing its trials and Covid isn't going to have helped that progress. Descovy is basically Truvada mark 2. Better at doing it's job so they can reduce the concentration of one of the drugs in the pill 10x. It's a lot easier on the Kidney's but has only been shown to be as effective as Truvada in treating HIV patients, not when used as PrEP. Of course there's every likeliness that it's going to be as good as Truvada as a prophylaxis but we need more data.
You cannot take Truvada if your kidney function is compromised so Descovy makes the most sense. It's likely to be as effective as Truvada when used as PrEP and will definitely be better than taking nothing.
My HIV+ friend was swapped onto Descovy once his kidney died. Why he wasn't swapped way before that happened I don't know and I blame the health service.
What I do not understand is why anyone taking PrEP would think it's giving them protection for any other STD. It's clear this is to prevent HIV infection and nothing else. Here, in the UK, when you get PrEP on the health service it's done in combination with a sexual health clinic. You have to have regular sexual health screening and blood tests to monitor your kidney function. You don't end up with an undiagnosed STD that kills you off, like was mentioned above. You could always buy PrEP from an independent source and then it falls on you to educate yourself and do what needs to be done. But if you're going to be buying, and taking, a powerful drug you should be educating yourself. If you don't, and you die, well that's your own damned fault.
Back when I was educated about HIV, at school, it was taught as a death sentence. Drugs will prolong your life but you will die from HIV. Today this hasn't changed. It's true that the drugs are capable of suppressing the virus to the extent that it won't be HIV that kills you directly, but the drugs take their toll on the body. Sure HIV won't kill you but the effect of the drugs will. You might still live until retirement age but the drugs will shorten your lifespan.
The kids are no longer afraid of HIV. It's no longer taught as a death sentence. Quite rightly so. But nevertheless I can't help but think that they do still need to take the disease more seriously. Just because we can treat it more effectively doesn't mean you can go bareback across the country because you like being loaded with cum, but that's what they do. Of course not everyone thinks this about it but there's a much more casual attitude towards it than there once was.
As far as I'm concerned nothing has really changed. What was important then is still just as important now. Educate yourself and keep yourself protected from the disease. Fail to do so and you'll suffer in one way or another. Either from failure to test for other STDs when on PrEP, or from the HIV medication itself.
