Gastrointestinal (GI) intolerance is among the leading causes of pre-exposure prophylaxis (PrEP) discontinuation, affecting 10%–20% of users in real-world cohorts,
We conducted a retrospective observational study using routinely collected electronic patient record data from individuals referred for PrEP-related GI intolerance between December 2021 and October 2025. Referral was triggered by PrEP discontinuation or suboptimal adherence attributable to GI side effects, following an initial assessment by the prescribing clinician, distinguishing this cohort from those experiencing transient start-up syndrome. Among 88 PrEP users (98% cisgender men; median age 34 years), nausea (61%) and diarrhoea (37%) were the most commonly reported GI symptoms. Study population…