Incident hypertension and statin initiation is more likely with the use of tenofovir alafenamide fumarate (TAF) than tenofovir disoproxil fumarate (TDF) in patients receiving HIV pre-exposure prophylaxis (PrEP), according to results of a study published in JAMA Network Open.
Researchers conducted a retrospective study to assess the risk for incident hypertension and statin initiation among patients receiving TAF- vs TDF-based HIV PrEP. Data were captured from 6824 adult patients (mean age, 33.9 years; 97% men) who initiated HIV PrEP between October 2019 and May 2022. The primary outcomes were incident hypertension and statin initiation, occurring between 30 days and 2 years following PrEP initiation. Incident hypertension was defined the occurrence of at least 2 abnormal outpatient blood pressure measurements; statin initiation was confirmed via outpatient pharmacy dispensing records.
The researchers divided patients into 2 cohorts, including those without hypertension at baseline (n=1855; hypertension cohort) and those with no history of prevalent statin use (n=6149; statin cohort). For both cohorts, propensity score matching was used to match patients receiving TAF-based PrEP 1:4 against those receiving TDF-based PrEP.
Among patients in the hypertension cohort, incident hypertension was more likely to occur among those receiving TAF- vs TDF-based PrEP (odds ratio [OR], 1.64; 95% CI, 1.05-2.56). However, results of a time-to-event analysis showed that TAF-based PrEP use was not significantly associated with incident hypertension (hazard ratio [HR], 1.63; 95% CI, 0.67-3.96).
Among patients in the statin cohort, those receiving TAF were more likely than those receiving TDF to initiate statins (OR, 2.33; 95% CI, 1.41-3.85). As with the hypertension cohort, the association between TAF use and statin initiation was not significant in the time-to-event analysis (HR, 2.26; 95% CI, 0.76-6.69).
Sensitivity analyses were conducted in both cohorts among patients aged 40 years and older at PrEP initiation. For patients in the hypertension cohort, receipt of TAF was associated with increased risk for incident hypertension (HR, 2.32; 95% CI, 1.12-4.81), though blood pressure measurements of 130/80 mm Hg constituted hypertension for this analysis. For patients in the statin cohort, the difference in risk between TAF vs TDF use and statin initiation was greater when compared with findings from the main analysis.
Study limitations include potential confounding by indication due to the observational design, the inability to account for PrEP adherence, and the relatively small number of TAF recipients.
Based on these findings, “Closer monitoring of blood pressure and lipid levels may be warranted if using TAF,” the researchers concluded.
Disclosures: Multiple study authors reported affiliations with pharmaceutical, biotech, and/or device companies. Please see the original reference for a full list of disclosures.
Rivera AS, Pak KJ, Mefford MT, Hechter RC. Use of tenofovir alafenamide fumarate for HIV pre-exposure prophylaxis and incidence of hypertension and initiation of statins. JAMA Netw Open. Published online September 11, 2023. doi:10.1001/jamanetworkopen.2023.32968