Researchers Compare PrEP Treatments for Hypertension Risks

New study results showed an elevated risk among patients taking tenofovir alafenamide fumarate (TAF) for HIV pre-exposure prophylaxis (PrEP), who began PrEP at 40 years of age or older.

Researchers assessed the use of TAF and its effect on cardiometabolic health, with findings published in JAMA Network. The researchers conducted a study that provided insights into the risk of incident hypertension and statin initiation among individuals starting PrEP and TAF compared to tenofovir disoproxil fumarate (TDF).

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PrEP was created to protect individuals who are at high risk of developing HIV. The researchers identified individuals who are deemed as high risk due to having a sexual partner with HIV, having multiple sexual partners, injecting drugs, and/or having a history of sexually transmitted infections.

TAF is one of the medications used for HIV PrEP to prevent infection. Researchers note that TAF is a newer version of TDF and is known to have benefits on kidney and bone health, according to the investigators.

The researchers conducted a retrospective cohort study of individuals beginning PrEP in Kaiser Permanente Southern California (KPSC) using data from electronic health records (EHRs). The study used 2 analytic cohorts—1 assessed the risk of incident hypertension and 1 assessed the risk of statin initiation. The researchers used each cohort to create propensity score-matched cohorts of 1 TAF: 4 TDF.

The researchers calculated baseline covariates that included age, sex, and EHR-reported race and ethnicity for both cohorts to compare individuals that began PrEP with TAF versus TDF. The press release noted that the researchers used propensity score matching to evaluate the covariate imbalance to avoid bias. The matching score ratio was 1:4—1 TAF matched with 4 individuals taking TDF. The researchers then used the matching to analyze the differences in incident outcome risk between TAF users and the same users if they used TDF.

“We performed a sensitivity analysis among a subset of individuals 40 years or older at PrEP initiation because practice guidelines recommend statin initiation in this age group and the onset of hypertension is more likely in this age group. Another sensitivity analysis was conducted by defining hypertension using the cutoff value of SBP/DBP levels of 130/80 mm Hg or higher,” said the study authors.

The researchers assessed 6824 individuals that were eligible to start PrEP. The average age was 34 years and 97% of individuals were men. To identify the risk of incident hypertension the researchers analyzed 5523 individuals without baseline hypertension— 371 individuals took TAF and 5152 took TDF. Then, the researchers identified 6149 individuals without statin use—382 individuals took TAF and 5767 took TDF.

The results found that individuals that took TAF had a higher risk of incident hypertension and statin initiation within 2 years after starting PrEP. In individuals 40 years and older, the researchers found that the risk for statin initiation was higher than the total cohort in those who took TAF compared to those who took TDF. The press release noted that this could mean that TAF could have a greater risk for different age groups. Weight gain was also reported when taking TAF or switching from TDF to TAF, affecting blood pressure and hypertension risk through sodium balance.

The findings suggest that if taking TAF, a close monitoring of blood pressure and lipid levels is essential due to greater risk of hypertension.

Reference

Use of Tenofovir Alafenamide Fumarate for HIV Pre-Exposure Prophylaxis and Incidence of Hypertension and Initiation of Statins. JAMA Network. New release. September 11, 2023. Accessed September 19, 2023. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809151?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=091123.