Patient-Focused Selection of PrEP Medication for Individuals at Risk of HIV: A Narrative Review

Fields, Sheldon D.; Tung, Elyse

doi:10.1007/s40121-020-00384-5

Cited by 14 publications

(15 citation statements)

References 89 publications

(129 reference statements)

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“…Some clinicians recommended to prescribe upgraded ART drugs to eliminate the potential risks ( 34 – 36 ). Also the updated guidelines for PrEP in the United States recommended the use of updated PrEP drugs (emtricitabine/tenofovir alafenamide [Descovy ® F/TAF]) ( 37 ) because of its less side effect on bone and good efficacy ( 38 ). However, these updated drugs were more expensive.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D and Calcium Supplementation Reverses Tenofovir-Caused Bone Mineral Density Loss in People Taking ART or PrEP: A Systematic Review and Meta-Analysis

Liu

Zhang

et al. 2022

Front. Nutr.

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BackgroundThe decrease of bone mineral density (BMD) after the intake of Tenofovir disoproxil fumarate (TDF)-based drugs in people living with HIV/AIDS (PLWHA) and HIV-negative key populations under pre-exposure prophylaxis (PrEP) regimen raised concerns. Previous findings on the effects of vitamin D (VD) and calcium supplements and the recovery of BMD loss were inconclusive. The optimal doses of VD and calcium and its supplementary duration remained unknown. Therefore, we conducted a systematic review and meta-analysis to synthesize current evidence on VD and calcium supplements to inform clinical practice.MethodsWe searched PubMed, Web of Science, Cochrane library, and EMBASE databases for all placebo-controlled trials and prospective cohort studies published before March 5, 2021 that investigated VD and calcium supplements in participants taking TDF-based drugs. The keywords calcium, vitamin D, Tenofovir, and BMD were used for the searches. The primary outcome was changes of spine and hip BMD. A subgroup analysis was performed to determine the factors that were related to the effects of VD supplements on BMD. Locally weighted regression (loess) was used to determine the relationships of VD supplements, supplementary duration, and changes of BMD. This study was registered at PROSPERO (No. 42021231000).FindingsSeven eligible studies including 703 participants were included in the analyses. The meta-analysis found that VD and calcium supplementation was related to a significant increase of BMD in the spine and hip [standardized mean difference (SMD) 0.43; 95% CI, 0.25 to 0.61, p = 0.009]. Moreover, positive dose-response relationships were demonstrated between doses of VD and calcium supplements, supplementary duration, and BMD recovery. Patients who took VD with the dose level of 4,000 IU/D obtained the highest BMD improvement (SMD 0.59, 95% CI, 0.43 to 0.74). No side effects were reported on VD and calcium supplementation.InterpretationWe found the VD and calcium supplementation was associated with increases of BMD in participants taking TDF-based drugs. An optimal supplementary dose of 4,000 IU/D for VD was suggested for clinicians. The findings could be used in clinical practice to improve the BMD outcomes in people who were taking TDF-based drugs.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/.

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Section: Discussionmentioning

confidence: 99%

Vitamin D and Calcium Supplementation Reverses Tenofovir-Caused Bone Mineral Density Loss in People Taking ART or PrEP: A Systematic Review and Meta-Analysis

Liu

Zhang

et al. 2022

Front. Nutr.

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“…An age-associated decline in glomerular filtration rate (GFR) is observed in longitudinal and cross-sectional studies [ 59 , 60 ]. Some populations are at an increased risk of accelerated kidney dysfunction due to concomitant medications [ 61 – 63 ], lifestyle (e.g., tobacco use, alcohol, and illicit substance use disorders) [ 64 – 66 ], comorbidities (e.g., hypertension, diabetes, established cardiovascular disease, as well as and family history) [ 61 ]. The presence of albuminuria, even with preserved estimated GFR (eGFR), is meaningful as it is known to increase the progression of renal disease.…”

Section: Renal Considerations and Supporting Evidencementioning

confidence: 99%

“…These effects of PrEP on BMD are important, even in a younger population that may easily recover from fracture events because many individuals remain on PrEP for many years. Once peak BMD is established, typically by 30 years of age [ 61 ], it slowly declines throughout the remainder of the lifespan [ 82 ]. In individuals who are on PrEP between the ages of 20 and 30 years old, the medication may reduce bone accretion leading to a lower peak bone mass.…”

Section: Bone Considerations and Supporting Evidencementioning

confidence: 99%

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Clinical Considerations in the Selection of Preexposure Prophylaxis for HIV Prevention in Canada

Knox

Pilarski

Dhunna

et al. 2022

Canadian Journal of Infectious Diseases and Medical Microbiolog

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According to the Public Health Agency of Canada, approximately 62,050 people were living with HIV in Canada in 2018, and of those, 13% were undiagnosed. Currently, no single strategy provides complete protection or is universally effective across all demographic groups at risk for HIV. However, HIV preexposure prophylaxis (PrEP) is the newest HIV prevention strategy that shows promise. To date, two products have received an indication for PrEP by Health Canada: emtricitabine/tenofovir disoproxil fumarate (Truvada®; FTC/TDF) and emtricitabine/tenofovir alafenamide (Descovy®; FTC/TAF). Despite the high efficacy of these PrEP intervention methods, access to PrEP in Canada remains low. Identifying and addressing barriers to PrEP access, especially in high-risk groups, are necessary to reduce HIV transmission in Canada. While guidelines published by the Center for Disease Control and Prevention (CDC) include FTC/TAF information, the efficacy of FTC/TAF for PrEP has not yet been considered in Canada’s clinical practice guidelines. Thus, the current paper reviews data regarding the use of FTC/TDF and FTC/TAF for PrEP, which may be useful for Canadian healthcare providers when counseling and implementing HIV prevention methods. The authors highlight these data in relation to various at-risk populations and review ongoing clinical trials investigating novel PrEP agents. Overall, FTC/TDF PrEP is effective for many populations, including men who have sex with men, transgender women, heterosexuals with partners living with HIV, and people who use drugs. While there is fewer data reported on the efficacy of FTC/TAF to date, recent clinical trials have demonstrated noninferiority of FTC/TAF in comparison to FTC/TDF. Notably, as studies have shown that FTC/TAF maintains renal function and bone mineral density to a greater extent than FTC/TDF, FTC/TAF may be a safer option for patients experiencing renal and/or bone dysfunction, for those at risk of renal and bone complications, and for those who develop FTC/TDF-related adverse events.

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“…An ever-growing epidemic of syphilis has been reported mainly among men who have sex with men (MSM), which is driven by online social networking, condomless sex, group sex, and recreational drug use [ 2 ]. Individuals receiving biomedical HIV treatment and prevention are particularly at high risk for syphilis [ 3 , 4 ]. The surveillance data from the USA showed that primary and secondary syphilis were more prevalent among HIV-positive MSM (7.0%) than among HIV-negative MSM (3.4%) in 2018 [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Comparisons of Serologic Responses of Early Syphilis to Treatment with a Single-Dose Benzathine Penicillin G Between HIV-Positive and HIV-Negative Patients

et al. 2021

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Introduction Poorer serologic responses of early syphilis to treatment have been inconsistently reported in HIV-positive patients compared with HIV-negative patients, but the interpretation of previous studies is limited by discrepant study designs. The present study aimed to evaluate the effect of HIV infection on the treatment response to a single dose of benzathine penicillin G (BPG) for early syphilis. Methods From January 2015 to March 2020, adult patients with early syphilis who received a single dose of BPG were enrolled and rapid plasma reagin (RPR) titers were periodically determined. The primary outcome was serologic response, defined as at least a fourfold decline of RPR titer at 12 months of BPG treatment compared with that at baseline, which was examined in the intention-to-treat (ITT) and per-protocol analyses. Treatment failure included lack of at least a fourfold decline in RPR titers and at least a fourfold increase in RPR titers. Results We prospectively enrolled 184 HIV-positive and 68 HIV-negative participants with early syphilis, who were all men who have sex with men, with a higher proportion of previous syphilis (70.1%) and early latent syphilis (64.1%) among HIV-positive participants. In the ITT with last-observation-carried-forward analysis, HIV-positive participants had a significantly lower serologic response rate at 12 months of treatment than HIV-negative participants (73.4% vs. 91.2%). Of HIV-positive participants, 12.5% failed to achieve at least fourfold decline in RPR titers and 14.1% had at least a fourfold increase in RPR titers. The factors associated with 12-month serologic response were HIV infection (adjusted odds ratio [AOR] 0.33; 95% confidence interval [CI] 0.13–0.81) and RPR titer (per 1-log 2 increase, AOR 1.36; 95% CI 1.23–1.51). Conclusion HIV-positive patients with early syphilis had poorer serologic responses to BPG treatment than HIV-negative patients during a 12-month follow-up period. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00450-6.

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Patient-Focused Selection of PrEP Medication for Individuals at Risk of HIV: A Narrative Review

Cited by 14 publications

References 89 publications

Vitamin D and Calcium Supplementation Reverses Tenofovir-Caused Bone Mineral Density Loss in People Taking ART or PrEP: A Systematic Review and Meta-Analysis

Vitamin D and Calcium Supplementation Reverses Tenofovir-Caused Bone Mineral Density Loss in People Taking ART or PrEP: A Systematic Review and Meta-Analysis

Clinical Considerations in the Selection of Preexposure Prophylaxis for HIV Prevention in Canada

Comparisons of Serologic Responses of Early Syphilis to Treatment with a Single-Dose Benzathine Penicillin G Between HIV-Positive and HIV-Negative Patients

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