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Editorial Commentary: Unmasking the Bare Bones of HIV Preexposure Prophylaxis.

prevention therapy. It is thus noteworthy that the available regimen for PrEP, the daily use of a fixed-dose combination of oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF), contains tenofovir (TFV). TFV causes renal toxicity, via a proximal tubulopathy, and bone demineralization, by increasing bone turnover and altering bone metabolism, in a minority of patients [6]. In general, low bone mineral density (BMD) occurs more frequently in treated HIV adults than in seronegative individuals [7]. Low BMD is associated with an increased risk of fragility fractures [8, 9]. The etiology of low BMD is multifactorial, including both HIV- and cART-related factors [10], plus common causes of low BMD, as occurs in seronegative persons [11], including low body weight [12]. Currently available cART regimens are associated with a BMD decline of 4%–6%, generally occurring in the 4–6 months after starting treatment, and which is nonprogressive [10]. TFV-HAART is associated with greater BMD loss compared with non-TFV regimens [7]. Significantly, TFV-HAART has been associated with an increased fracture risk compared with other regimens in some studies [13]. In this context, Mulligan et al have