HIV PrEP TAF Associated to Increased Hypertension and Statin Use, Especially For Older Users, Study Finds

There is a higher risk of hypertension, or high blood pressure, and statin use among those who use the HIV pre-exposure prophylaxis tenofovir alafenamide fumarate (TAF), especially for those who began its use at age 40 years and older.

Pre-exposure prophylaxis (PrEP) is an effective component for reducing the risk of HIV infection in the United States. There are currently two daily oral PrEP regimens that are approved by the US Food and Drug Administration: emtricitabine/tenofovir disoproxil fumarate (TDF), which was approved in 2012, and TAF, approved in 2019.

While previous trials have demonstrated these two regimens are comparable in terms of effects for HIV prevention and overall safety, data from a DISCOVER study published in THE LANCET in 2021 showed that individuals taking TAF for PrEP had better bone and kidney health markers than those taking TDF. The study showed a number of other different health effects.

In a JAMA Network Open study published Sept. 11, researchers wanted to take a deeper look into PrEP regimens’ impact on cardiometabolic health, as it is understudied. To do so they examined the risk of incident hypertension and statin use among adult health plan members starting PrEP with TAF compared adults taking TDF.

The retrospective cohort study reviewed electronic health records (EHRs) from Kaiser Permanente Southern California members starting PrEP between October 2019 and May 2022. 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, according to the study.

Hypertension and statin use within 2 years of PrEP initiation were monitored through blood pressure and outpatient EHRs. Risk differences and odds ratios (ORs) were estimated using logistic regression and g-computation.

The result, a total of 6,824 eligible individuals were identified in the study. 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, TAF use was associated with elevated risk of incident hypertension (n = 371; risk difference, 0.81 [95% CI, 0.12-1.50]; OR, 1.64 [95% CI, 1.05- 2.56]), and with an elevated risk of statin use (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 use (risk difference, 4.24 [95% CI, 1.82-6.26]; OR, 3.05 [95% CI, 1.64-5.67]).

Data shared that the higher occurrence of hypertension and statin use may be due to weight and lipid-level changes associated with TAF. In those with HIV, folks who took therapies containing TAF exhibited greater weight gain and increased LDL-C compared with those who took TDF.

People who also switched from TDF to TAF had a higher chance of weight gain and worsening of lipid profiles. The weight gain may affect blood pressure and hypertension risk through neurohormonal pathways controlling sodium balance, the study said.

Though the study supplied significant results, researcher encourage that future studies with larger sample size and longer follow-up periods should provide more evidence to inform clinical decision-making regarding different PrEP regimens, especially among those with increased risk for cardiometabolic disease.