Use of Tenofovir Alafenamide Fumarate for HIV Pre-Exposure Prophylaxis and Incidence of Hypertension and Initiation of Statins

Abstract

ImportancePre-exposure prophylaxis (PrEP) is an important tool for preventing HIV infection. However, PrEP’s impact on cardiometabolic health is understudied.ObjectiveTo examine the risk of incident hypertension and statin initiation among adult (age ≥18 years) health plan members starting PrEP with tenofovir alafenamide fumarate (TAF) compared with propensity score–matched adults taking tenofovir disoproxil fumarate (TDF).Design, Setting, and ParticipantsThis retrospective cohort study used electronic health records (EHRs) from Kaiser Permanente Southern California. Adult members starting PrEP in Kaiser Permanente Southern California between October 2019 and May 2022 were included. Propensity score matching with multiple imputation (50 matched data sets) was conducted to generate 1 TAF:4 TDF matched data sets with balanced baseline covariates.ExposuresPrEP initiation with either TAF or TDF during the study period.Main Outcomes and MeasuresIncident hypertension and statin initiation within 2 years of PrEP initiation were ascertained through blood pressure and outpatient pharmacy records, respectively. Risk differences and odds ratios (ORs) were estimated using logistic regression and g-computation.ResultsA total of 6824 eligible individuals were identified (mean [SD] age, 33.9 [10.3] years; 6618 [97%] male). This pool was used to generate 2 cohorts without baseline hypertension or statin use for matching (hypertension: n = 5523; statin: n = 6149) In both cohorts, those starting PrEP with TAF were older and were more likely to be non-Hispanic White compared with those starting with TDF. In matched analysis adjusting for baseline covariates, TAF use was associated with elevated risk of incident hypertension (TAF: n = 371; risk difference, 0.81 [95% CI, 0.12-1.50]; OR, 1.64 [95% CI, 1.05-2.56]). TAF use was also associated with elevated risk of statin initiation (TAF: n = 382; risk difference, 0.85 [95% CI, 0.37-1.33]; OR, 2.33 [95% CI, 1.41-3.85]). Subgroup analyses restricted to individuals 40 years and older at PrEP initiation showed similar results with larger risk difference in statin initiation (risk difference, 4.24 [95% CI, 1.82-6.26]; OR, 3.05 [95% CI, 1.64-5.67]).Conclusions and RelevanceIn this study of people taking PrEP, TAF use was found to be associated with higher incident hypertension and statin initiation compared with TDF use, especially in those 40 years or older. Continued monitoring of blood pressure and lipids for TAF users is warranted.

Blood pressure increases are associated with weight gain and not antiretroviral regimen or kidney function: a secondary analysis from the ADVANCE trial in South Africa

“…This study found a 14.2% increase in the risk of hypertension, alongside greater weight gain, in those who initiated DTG compared to those who initiated EFV. In addition, Rivera et al conducted a retrospective propensity‐score matched analysis of adults in California who were initiating TAF versus TDF for HIV pre‐exposure prophylaxis [ 30 ] and found that TAF use was associated with a modestly increased risk of incident hypertension. Third, an analysis of participants from the RESPOND cohort concluded that INSTIs as a class were associated with a higher incidence of hypertension than non‐nucleoside reverse transcriptase inhibitor (NNRTIs), but rates were similar in those who used protease inhibitors [ 11 ].…”

Rational Design and Characterization of Trispecific Antibodies Targeting the HIV-1 Receptor and Envelope Glycoprotein

“…Currently, the primary pre-exposure prophylactic drugs for HIV-1 that have been marketed are Tenofovir Alafenamide (TAF) [ 2 , 3 ] and Dapivirine [ 4 , 5 ]. However, these drugs may have some side effects, and there are also some HIV-1-resistant strains [ 6 , 7 ]. Developing new and practical pre-exposure prophylactic drugs against HIV-1 can help humans more effectively prevent HIV-1 infection.…”