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Legoabe Z, Sebitloane M, Lombard C, Naidoo M, Gray G, Moodley D. Development of normal reference intervals for renal function in pregnancy: a secondary analysis of clinical trial data. J OBSTET GYNAECOL 2024; 44:2361445. [PMID: 38832538 DOI: 10.1080/01443615.2024.2361445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/22/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Due to its potential nephrotoxicity, screening for pre-existing renal function disorders has become a routine clinical assessment for initiating Tenofovir diphosphate fumarate (TDF)-containing antiretroviral treatment (ART) or pre-exposure prophylaxis (PrEP) in pregnant and non-pregnant adults. We aimed to establish reference values for commonly used markers of renal function in healthy pregnant women of African origin. METHODS Pregnant women ≥18 years, not living with HIV, and at 14-28 weeks gestation were enrolled in a PrEP clinical trial in Durban, South Africa between September 2017 and December 2019. Women were monitored 4-weekly during pregnancy until six months postpartum. We measured maternal weight and serum creatinine (sCr) at each visit and calculated creatinine clearance (CrCl) rates using the Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulae. Reference ranges for sCr and CrCl by CG and MDRD calculations were derived from the mean ± 2SD of values for pregnancy and postdelivery. RESULTS Between 14--and 40 weeks gestation, 249 African women not exposed to TDF-PrEP contributed a total of 1193 renal function values. Postdelivery, 207 of these women contributed to 800 renal function values. The normal reference range for sCr was 30-57 and 32-60 umol/l in the 2nd and 3rd trimesters of pregnancy. Normal reference ranges for CrCl using the MDRD calculation were 129-282 and 119-267 ml/min/1.73m2 for the 2nd and 3rd trimesters, respectively. Using the CG method of calculation, normal reference ranges for CrCl were 120-304 and 123-309 ml/min/1.73m2 for the 2nd and 3rd trimesters respectively. In comparison, the normal reference range for sCr, CrCl by MDRD and CG calculations postpartum was 40-77 umol/l, 92-201, and 90-238 ml/min/1.73m2, respectively. CONCLUSIONS In African women, the Upper Limit of Normal (ULN) for sCr in pregnancy is approximately 20% lower than 6 months postnatally. Inversely, the Lower Limit of Normal (LLN) for CrCl using either MDRD or CG equation is approximately 35% higher than 6 months postnatally. We provide normal reference ranges for sCr and CrCl for both methods of calculation and appropriate for the 2nd and 3rd trimesters of pregnancy in African women.
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Affiliation(s)
- Zandile Legoabe
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Motshedisi Sebitloane
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, University of Stellenbosch, Tygerberg, South Africa
| | - Megeshinee Naidoo
- Centre for the Program of AIDS Research in South Africa (CAPRISA), Durban, South Africa
| | - Glenda Gray
- South African Medical Research Council, Cape Town, South Africa
| | - Dhayendre Moodley
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
- Centre for the Program of AIDS Research in South Africa (CAPRISA), Durban, South Africa
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Cornelisse VJ, Murphy D, Lee SJ, Stoove M, Traeger MW, Wright EJ. Physical and mental health of long-term users of HIV preexposure prophylaxis in Australia. AIDS 2024; 38:363-372. [PMID: 37877295 DOI: 10.1097/qad.0000000000003768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
INTRODUCTION HIV preexposure prophylaxis (PrEP) is highly effective at preventing HIV. We aimed to assess mental and physical health among long-term PrEP users in Australia's X-PLORE cohort. METHODS In early 2021, 1485 X-PLORE participants were emailed a survey covering demographics, sexual practices, ongoing PrEP use, physical and psychological diagnoses received since commencing PrEP, substance use, and impacts of the COVID-19 pandemic. Current anxiety and depression were assessed using GAD-7 and PHQ-9 questionnaires. RESULTS Of 476 participants (completion rate 32.1%), 99.8% were cis-gender men. Median PrEP use duration was 48 months (2002 person-years), with 81.7% currently using PrEP. PrEP-related toxicity was uncommon: 2.9% reported bone fractures, 1.3% low bone density, and 4.0% reported kidney problems, largely not necessitating PrEP cessation. Most (92.0%) rated their health as 'good' to 'excellent', and 22.6% reported improved health since starting PrEP, often because of improved mental health. Only 6.2% reported deterioration in health since starting PrEP, largely unrelated to PrEP. The most common diagnoses were hypertension (9.9%), depression (13.2%) and anxiety (14.9%); 17% had PHQ-9 scores indicating current moderate-to-severe depression, which was associated with unemployment [adjusted odds ratio (aOR) 3.90], regular cannabis use (aOR 2.49), and having ceased PrEP (aOR 2.13). CONCLUSION Among long-term PrEP users, of which over 80% were currently using PrEP, self-reported PrEP toxicity was uncommon. With almost one in five PrEP users categorized as having depression, and with higher risk among those having ceased PrEP, we recommend routine screening for depression and anxiety in PrEP users and corresponding follow-up of patients no longer attending for PrEP.
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Affiliation(s)
- Vincent J Cornelisse
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
- The Kirby Institute, UNSW Sydney, Sydney
| | - Dean Murphy
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
- The Kirby Institute, UNSW Sydney, Sydney
| | - Sue J Lee
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
| | - Mark Stoove
- Burnet Institute
- Australian Research Centre in Sex, Health and Society, LaTrobe University
- School of Public Health and Preventive Medicine, Monash University
| | - Michael W Traeger
- Burnet Institute
- School of Public Health and Preventive Medicine, Monash University
| | - Edwina J Wright
- Department of Infectious Diseases, The Alfred Hospital
- Monash University, Central Clinical School, Dept of Infectious Diseases, Melbourne
- Burnet Institute
- Doherty Institute, Melbourne, Australia
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Liegeon G, Brun A, Hamet G, Zeggagh J, Pintado C, Loze B, Ponscarme D, Rozenbaum W, Molina JM. Brief Report: Incidence and Management of Complex Kidney Situations Among On-Demand and Daily HIV Pre-Exposure Prophylaxis Users. J Acquir Immune Defic Syndr 2024; 95:255-259. [PMID: 37977193 DOI: 10.1097/qai.0000000000003346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND We evaluated complex pre-exposure prophylaxis (PrEP) situations linked to kidney issues in a cohort of on-demand and daily PrEP users. SETTING We conducted a single-center retrospective cohort study in France including all PrEP users who received a tenofovir disoproxil (TD)-emtricitabine (FTC) prescription between January 1, 2012 and December 31, 2019 with at least 1 creatinine measurement available before and after PrEP initiation. METHODS A complex kidney situation (CKS) was defined as an estimated glomerular filtration rate (eGFR) <60 mL/minute/1.73m 2 on 2 consecutive measurements. We estimated the incidence of this event, described case management, and identified associated factors using a Cox model. RESULTS Three thousand one hundred and fourteen individuals were included in this study. Almost all were men (99%) with a median age of 35 years, 25% had an eGFR <90 mL/minute/1.73m 2 at baseline, and 65% used on-demand PrEP. Nine users (0.29%) had a CKS at baseline; 8/9 initiated on-demand PrEP without renal function worsening after a median (interquartile range [IQR]) follow-up time of 14 months (7-31). Thirteen cases of CKS occurred during the follow-up for a 0.25 per 100 person-years incidence (95% confidence interval [CI]: [0.14; 0.45]). On-demand PrEP was used in 7/13 participants with no further episode of confirmed eGFR <60 mL/minute/1.73m 2 after a 17-month median follow-up (IQR 4-18). CKS was associated with an age ≥50 years (hazard ratio [HR] 13, 95% CI: [4-39]) or with a baseline eGFR <90 mL/minute/1.73m 2 (HR 34, 95% CI: [4-261]). 9/22 CKS were linked to high-protein intake for weight training. CONCLUSIONS CKS were rare in our cohort. On-demand PrEP did not result in subsequent renal function worsening in these few situations.
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Affiliation(s)
- Geoffroy Liegeon
- Department of Infectious Diseases and Global Health, University of Chicago, Chicago, IL
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint Louis et Lariboisière, Department of Infectious Diseases, Paris, France
| | - Alexandre Brun
- COREVIH Ile de France Est, Hôpital Saint Louis, Paris, France
| | - Gwenn Hamet
- COREVIH Ile de France Est, Hôpital Saint Louis, Paris, France
| | - Jeremy Zeggagh
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint Louis et Lariboisière, Department of Infectious Diseases, Paris, France
| | - Claire Pintado
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint Louis et Lariboisière, Department of Infectious Diseases, Paris, France
- Service de Prévention et Santé Communautaire, Hôpital Intercommunal de Créteil, Créteil, France
| | - Bénédicte Loze
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint Louis et Lariboisière, Department of Infectious Diseases, Paris, France
| | - Diane Ponscarme
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint Louis et Lariboisière, Department of Infectious Diseases, Paris, France
| | - Willy Rozenbaum
- COREVIH Ile de France Est, Hôpital Saint Louis, Paris, France
| | - Jean-Michel Molina
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint Louis et Lariboisière, Department of Infectious Diseases, Paris, France
- Paris Cité University, Paris, France
- INSERM UMR 944, Paris, France
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Pereira M, Castro CTD, Magno L, Oliveira TDA, Gomes FS, Neves FMF, Nascimento PRDSD, Dourado I. Adverse effects of daily oral pre-exposure prophylaxis in men who have sex with men and transgender women: a systematic review and meta-analysis. CAD SAUDE PUBLICA 2023; 39Suppl 1:e00089522. [PMID: 38088646 PMCID: PMC10712916 DOI: 10.1590/0102-311xen089522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 12/18/2023] Open
Abstract
The adverse effects of oral pre-exposure prophylaxis (PrEP) using tenofovir disoproxil fumarate are barriers to PrEP initiation and continuation. Although serious effects are rare and predictable, evidence for this assessment among men who have sex with men (MSM) and transgender women (TGW) is still limited. This study assesses the adverse effects of daily oral PrEP in MSM and TGW. This is a systematic review and meta-analysis of clinical trials and cohort studies on the use of daily oral PrEP selected from the PubMed/MEDLINE, Embase, LILACS, and Cochrane CENTRAL databases. Data extraction included adverse effects and changes in renal and hepatic markers. Random effects models were used to summarize the risk of adverse effects throughout the study. Heterogeneity was assessed using the Cochran's Q test and the inconsistency test (I2). The risk of bias and the certainty of the evidence were assessed using the Cochrane Collaboration recommendations. The search identified 653 references. Of these, 10 were selected. All studies assessed the eligibility of renal and hepatic markers. The use of daily oral PrEP was not associated with grade 3 or 4 adverse events (RR = 0.99; 95%CI: 0.83-1.18; I2 = 26.1%), any serious adverse event (RR = 1.04; 95%CI: 0.58-1.87; I2 = 88.4%), grade 3+4 creatinine level (RR = 0.66; 95%CI: 0.24-1.84; I2 = 79.9%), and grade 3 or 4 hypophosphatemia (RR = 0.56; 95%CI: 0.15-2.10). The certainty of the evidence ranged from high to moderate for the outcomes analyzed. Daily oral PrEP is safe and well tolerated by MSM and TGW. Adverse effects were minimal and evenly distributed between intervention and control.
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Affiliation(s)
- Marcos Pereira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | - Laio Magno
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brasil
| | | | | | | | | | - Ines Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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Joseph Davey DL, Wilkinson L, Grimsrud A, Nelson A, Gray A, Raphael Y, Wattrus C, Pillay Y, Bekker LG. Urgent appeal to allow all professional nurses and midwives to prescribe pre-exposure prophylaxis (PrEP) in South Africa. S Afr Med J 2023; 113:12-16. [PMID: 37882113 DOI: 10.7196/samj.2023.v113i8.1191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- D L Joseph Davey
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa; Division of Infectious Diseases, Geffen School of Medicine, University of California Los Angeles, USA; Desmond Tutu HIV Centre, University of Cape Town, South Africa.
| | - L Wilkinson
- Centre for Infectious Disease and Epidemiological Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa; International AIDS Society, Johannesburg, South Africa.
| | - A Grimsrud
- International AIDS Society, Johannesburg, South Africa.
| | - A Nelson
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - A Gray
- Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Y Raphael
- Advocacy for Prevention of HIV and AIDS, Johannesburg, South Africa.
| | - C Wattrus
- Southern African HIV Clinicians Society, Johannesburg, South Africa.
| | - Y Pillay
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - L-G Bekker
- Desmond Tutu HIV Centre, University of Cape Town, South Africa.
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Gangcuangco LMA, Eustaquio PC. The State of the HIV Epidemic in the Philippines: Progress and Challenges in 2023. Trop Med Infect Dis 2023; 8:tropicalmed8050258. [PMID: 37235306 DOI: 10.3390/tropicalmed8050258] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/14/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
In the past decade, the Philippines has gained notoriety as the country with the fastest-growing human immunodeficiency virus (HIV) epidemic in the Western Pacific region. While the overall trends of HIV incidence and acquired immunodeficiency syndrome (AIDS)-related deaths are declining globally, an increase in new cases was reported to the HIV/AIDS and ART Registry of the Philippines. From 2012 to 2023, there was a 411% increase in daily incidence. Late presentation in care remains a concern, with 29% of new confirmed HIV cases in January 2023 having clinical manifestations of advanced HIV disease at the time of diagnosis. Men having sex with men (MSM) are disproportionately affected. Various steps have been taken to address the HIV epidemic in the country. The Philippine HIV and AIDS Policy Act of 2018 (Republic Act 11166) expanded access to HIV testing and treatment. HIV testing now allows for the screening of minors 15-17 years old without parental consent. Community-based organizations have been instrumental in expanding HIV screening to include self-testing and community-based screening. The Philippines moved from centralized HIV diagnosis confirmation by Western blot to a decentralized rapid HIV diagnostic algorithm (rHIVda). Dolutegravir-based antiretroviral therapy is now the first line. Pre-exposure prophylaxis in the form of emtricitabine-tenofovir disoproxil fumarate has been rolled out. The number of treatment hubs and primary HIV care facilities continues to increase. Despite these efforts, barriers to ending the HIV epidemic remain, including continued stigma, limited harm reduction services for people who inject drugs, sociocultural factors, and political deterrents. HIV RNA quantification and drug resistance testing are not routinely performed due to associated costs. The high burden of tuberculosis and hepatitis B virus co-infection complicate HIV management. CRF_01AE is now the predominant subtype, which has been associated with poorer clinical outcomes and faster CD4 T-cell decline. The HIV epidemic in the Philippines requires a multisectoral approach and calls for sustained political commitment, community involvement, and continued collaboration among various stakeholders. In this article, we outline the current progress and challenges in curbing the HIV epidemic in the Philippines.
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Affiliation(s)
- Louie Mar A Gangcuangco
- Hawaii Center for AIDS, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI 96813, USA
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Mokgalaboni K, Phoswa WN, Yates S, Lebelo SL, Madiba S, Modjadji P. A Systematic Review and Meta-Analysis on the Impact of Statin Treatment in HIV Patients on Antiretroviral Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095668. [PMID: 37174188 PMCID: PMC10177940 DOI: 10.3390/ijerph20095668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
The rate of new human immunodeficiency virus (HIV) infections globally is alarming. Although antiretroviral therapy (ART) improves the quality of life among this group of patients, ARTs are associated with risk of cardiovascular diseases (CVD). Moreover, virally suppressed patients still experience immune activation associated with HIV migration from reservoir sites. Statins are widely recommended as therapeutic agents to control ART-related CVD; however, their impacts on the cluster of differentiation (CD)4 count and viral load are inconsistent. To assess the effect of statins on markers of HIV infections, immune activation and cholesterol, we thoroughly reviewed evidence from randomised controlled trials. We found 20 relevant trials from three databases with 1802 people living with HIV (PLHIV) on statin-placebo treatment. Our evidence showed no significant effect on CD4 T-cell count standardised mean difference (SMD): (-0.59, 95% confidence intervals (CI): (-1.38, 0.19), p = 0.14) following statin intervention in PLHIV on ART. We also found no significant difference in baseline CD4 T-cell count (SD: (-0.01, 95%CI: (-0.25, 0.23), p = 0.95). Our findings revealed no significant association between statins and risk of viral rebound in PLHIV with undetectable viral load risk ratio (RR): (1.01, 95% CI: (0.98, 1.04), p = 0.65). Additionally, we found a significant increase in CD8+CD38+HLA-DR+ T-cells (SMD (1.10, 95% CI: (0.93, 1.28), p < 0.00001) and CD4+CD38+HLA-DR+ T-cells (SMD (0.92, 95% CI: (0.32, 1.52), p = 0.003). Finally, compared to placebo, statins significantly reduced total cholesterol (SMD: (-2.87, 95% CI: (-4.08, -1.65), p < 0.0001)). Our results suggest that the statin lipid-lowering effect in PLHIV on ART may elevate immune activation without influencing the viral load and CD4 count. However, due to the limited evidence synthesised in this meta-analysis, we recommend that future powered trials with sufficient sample sizes evaluate statins' effect on CD4 count and viral load, especially in virally suppressed patients.
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Affiliation(s)
- Kabelo Mokgalaboni
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Johannesburg 1709, South Africa
| | - Wendy Nokhwezi Phoswa
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Johannesburg 1709, South Africa
| | - Samantha Yates
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Johannesburg 1709, South Africa
| | - Sogolo Lucky Lebelo
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Florida Campus, Johannesburg 1709, South Africa
| | - Sphiwe Madiba
- Faculty of Health Sciences, University of Limpopo, Polokwane 0700, South Africa
| | - Perpetua Modjadji
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
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8
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Heron JE, McManus H, Vickers T, Ryan K, Wright E, Carter A, Stoove M, Asselin J, Grulich A, Donovan B, Guy R, Varma R, Chen M, Ryder N, Lewis DA, Templeton DJ, O’Connor CC, Gracey DM. Renal impairment associated with tenofovir disoproxil fumarate for antiretroviral therapy and HIV pre-exposure prophylaxis: An observational cohort study. PLoS One 2023; 18:e0280339. [PMID: 36827395 PMCID: PMC9955644 DOI: 10.1371/journal.pone.0280339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 12/27/2022] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Tenofovir disoproxil fumarate (TDF) is associated with adverse renal outcomes when prescribed for HIV infection. There are few data concerning real-world renal outcomes amongst patients prescribed TDF for pre-exposure prophylaxis (PrEP). METHODS AND FINDINGS Data were extracted from 52 sexual health clinics across Australia from 2009-2019. All patients prescribed TDF-containing antiretroviral therapy and PrEP were included. Rates of renal impairment (a fall in eGFR to <60 ml/min/1·73m2) were calculated for people living with HIV (PLWHIV) prescribed TDF and HIV negative PrEP-users. Risk factors were assessed using Cox-proportional hazards models. Sensitivity analysis of risk using 1:1 propensity-score matching to adjust for potential imbalance in HIV and PrEP cohorts was conducted. 5,973 patients on PrEP and 1,973 PLWHIV were included. There were 39 (0.7%) instances of renal impairment in the PrEP group and 81 (4.1%) in the PLWHIV cohort (hazard ratio [HR]:0.35 95% confidence interval [CI]: 0.22-0.56). Rates of renal impairment were 4.01/1000 person-years (95%CI:2.93-5.48) in the PrEP cohort and 16.18/1000 person-years (95%CI:13.01-20.11) in the PLWHIV cohort (p<0.001). Predictors of renal impairment were: older age (40-49 years (HR:5.09 95%CI: 2.12-12.17) and 50-82 years (HR:13.69 95%CI: 5.92-31.67) (compared with 30-39 years) and baseline eGFR<90ml/min (HR:61.19 95%CI: 19.27-194.30). After adjusting for age and baseline eGFR the rate of renal impairment remained lower in the PrEP cohort (aHR:0.62 95%CI: 0.40-0.94, p = 0.023). In propensity-matched analysis using 1,622 patients per cohort the risk of renal impairment remained higher in the PLWHIV cohort (log-rank p = 0.001). CONCLUSION Patients prescribed TDF-based PrEP had lower rates of renal impairment than patients prescribed TDF for HIV infection. In propensity analysis, after matching for some risk factors, rates of renal impairment remained higher amongst patients with HIV.
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Affiliation(s)
- Jack E. Heron
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Department of Medicine, Albury Wodonga Health, Wodonga, Victoria, Australia
- * E-mail:
| | - Hamish McManus
- The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Tobias Vickers
- The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Kathleen Ryan
- Department of Infectious Disease, Alfred Health, Melbourne, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
| | - Edwina Wright
- Department of Infectious Disease, Alfred Health, Melbourne, Victoria, Australia
- Burnet Institute, Melbourne, Victoria, Australia
- Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Allison Carter
- The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Victoria, Australia
| | | | - Andrew Grulich
- The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Basil Donovan
- The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - Rick Varma
- The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
- Sydney Sexual Health Centre, Sydney Hospital, Sydney, New South Wales, Australia
| | - Marcus Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Nathan Ryder
- The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
- Hunter New England Clinic, Tamworth, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - David A. Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, New South Wales, Australia
- Faculty of Medicine and Health, Westmead Clinical School, University of Sydney, Westmead, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Westmead, New South Wales, Australia
| | - David J. Templeton
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Department of Sexual Health Medicine and Sexual Assault Medical Service, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Catherine C. O’Connor
- The Kirby Institute, University of New South Wales, Kensington, New South Wales, Australia
| | - David M. Gracey
- Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
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9
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Liegeon G, Assoumou L, Ghosn J, El Mouhebb M, Palich R, Palacios C, Slama L, Surgers L, Genin M, Beniguel L, Goldwirt L, Duvivier C, Rojas Castro D, Costagliola D, Molina JM. Impact on renal function of daily and on-demand HIV pre-exposure prophylaxis in the ANRS-PREVENIR study. J Antimicrob Chemother 2022; 77:3427-3435. [PMID: 36205009 DOI: 10.1093/jac/dkac336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 09/13/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To assess the impact on the estimated glomerular filtration rate (eGFR) of different tenofovir disoproxil/emtricitabine dosing regimens for HIV pre-exposure prophylaxis (PrEP). PATIENTS AND METHODS We included in the study individuals with baseline eGFR > 50 mL/min/1.73 m2 who initiated PrEP in the ongoing ANRS-PREVENIR PrEP cohort. We retrospectively classified PrEP users in three groups: 'on-demand' (reported at ≥75% of study visits), 'daily' (≥75% of study visits) or 'switches'. We compared the area under curve (AUC) of the eGFR variation from baseline (ΔeGFR) between groups using analysis of covariance, and assessed factors associated with a negative AUC of ΔeGFR. RESULTS From May 2017 to October 2020, 1253 PrEP-naïve participants (98% of MSM) were included in the study with a median follow-up of 22 months. 499 (40%), 494 (39%) and 260 (21%) users were in the group daily, on-demand and switches, respectively, for a median number of pills taken per week of 6, 1.7 and 4. The mean AUC of the ΔeGFR was -1.09 mL/min/1.73 m2 in the daily PrEP group, -0.69 mL/min/1.73 m2 in the switches group and +0.18 mL/min/1.73 m2 with on-demand PrEP. In a model adjusted on baseline age and eGFR, the AUC of the ΔeGFR was significantly higher with on-demand PrEP compared to daily PrEP (P = 0.037). Independent factors associated with a negative AUC of ΔeGFR were a daily PrEP regimen, a switches regimen, an age > 40 years and a baseline eGFR≥90 mL/min/1.73 m². CONCLUSIONS On-demand PrEP dosing had a smaller impact on eGFR evolution than daily PrEP, but the difference was not clinically relevant.
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Affiliation(s)
- Geoffroy Liegeon
- Service des maladies infectieuses, Assistance publique - Hôpitaux de Paris (AP-HP), Hôpitaux Saint Louis et Lariboisière, Paris 75010, France.,Université Paris Cité, Paris 75006, France
| | - Lambert Assoumou
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris 75646, France
| | - Jade Ghosn
- Université Paris Cité, Paris 75006, France.,Service des maladies infectieuses, AP-HP, Hôpital Bichat, Paris 75018, France
| | | | - Romain Palich
- Service des maladies infectieuse, AP-HP, Hôpital Pitié Salpetrière, Paris 75013, France
| | - Christia Palacios
- Service des maladies infectieuse, AP-HP, Hôpital Tenon, Paris 75020, France
| | - Laurence Slama
- Service des maladies infectieuses, AP-HP, Hôpital Hôtel Dieu, Paris 75004, France
| | - Laure Surgers
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris 75646, France.,Service des maladies infectieuses, AP-HP, Hôpital Saint Antoine, Paris 75012, France
| | - Michèle Genin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris 75646, France
| | - Lydie Beniguel
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris 75646, France
| | - Lauriane Goldwirt
- Service de pharmacologie clinique, AP-HP, Hôpital Saint Louis, Paris 75010, France
| | - Claudine Duvivier
- Service des maladies infectieuses, AP-HP, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker Pasteur; IHU Imagine, Paris 75015, France.,Institut Cochin - CNRS 8104 - INSERM U1016 - RIL (Retrovirus, Infection, and Latency) Team, Université Paris Cité, Paris 75014, France.,Institut Pasteur, Centre Médical de l'Institut Pasteur, Paris 75015France
| | | | - Dominique Costagliola
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris 75646, France
| | - Jean-Michel Molina
- Service des maladies infectieuses, Assistance publique - Hôpitaux de Paris (AP-HP), Hôpitaux Saint Louis et Lariboisière, Paris 75010, France.,Université Paris Cité, Paris 75006, France.,INSERM UMR 941, Paris 75010, France
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10
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Chimbindi N, Shahmanesh M. PrEP dispensing with HIV self-testing. Lancet HIV 2022; 9:e450-e451. [PMID: 35777404 DOI: 10.1016/s2352-3018(22)00171-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Natsayi Chimbindi
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa; Institute for Global Health, University College London, London, UK; University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
| | - Maryam Shahmanesh
- Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa; Institute for Global Health, University College London, London, UK; University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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11
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Nelson A, Gray A, Bekker LG, Grimsrud A, Wilkinson LS, Davey DJ. Non-ART trained health-care workers needed to prescribe PrEP in South Africa. Lancet HIV 2022; 9:e458. [PMID: 35777407 PMCID: PMC10824361 DOI: 10.1016/s2352-3018(22)00139-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Aurelie Nelson
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa.
| | - Andy Gray
- Division of Pharmacology, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | | | | | - Lynne S Wilkinson
- International AIDS Society, Cape Town, South Africa; Center for Infectious Disease and Epidemiological Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Dvora Joseph Davey
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa; Division of Infectious Diseases, Geffen School of Medicine, University of California Los Angeles, LA, USA
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12
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Safety of oral tenofovir disoproxil - emtricitabine for HIV preexposure prophylaxis in adults. Curr Opin HIV AIDS 2022; 17:199-204. [PMID: 35762374 DOI: 10.1097/coh.0000000000000747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review focuses on the safety of oral tenofovir disoproxil and emtricitabine (FTC) combination for HIV preexposure prophylaxis (PrEP) in adults. RECENT FINDINGS Gastrointestinal adverse events are common after treatment initiation but usually resolve within weeks. Although clinical trials did not report an increased risk of serious renal adverse events or tubulopathy, meta-analyses suggest that tenofovir disoproxil -FTC is associated with a slight but non-clinically relevant decline in estimated glomerular filtration rate (eGFR). A decline to less than 60 mL/min remains a rare event, which mainly occurs in users with an age >50 years or a baseline creatinine clearance < 90 mL/min. Similarly, a slight reduction in bone mineral density (BMD) was observed in clinical trials, but it did not result in an increased risk of bone fracture. BMD reduction and eGFR decline tend to resolve after treatment discontinuation. No drug interaction with contraception has been reported in women and no safety signal emerged in pregnant and breastfeeding women. SUMMARY Oral tenofovir disoproxil-FTC for HIV PrEP appears safe and well tolerated for most individuals. This supports demedicalization strategies aiming at increasing the number of PrEP users.
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13
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Bragazzi NL, Khamisy-Farah R, Tsigalou C, Mahroum N. HIV Pre-exposure Prophylaxis and Its Impact on the Gut Microbiome in Men Having Sex With Men. Front Microbiol 2022; 13:922887. [PMID: 35814651 PMCID: PMC9260425 DOI: 10.3389/fmicb.2022.922887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/09/2022] [Indexed: 01/18/2023] Open
Abstract
HIV/AIDS still imposes a high epidemiological and societal burden. Together with antiretroviral therapy, pre-exposure prophylaxis (PrEP) represents a fundamental tool in the fight against HIV/AIDS. PrEP is considered effective and safe, even though it may affect organs like the kidney, bone, and liver, as shown by randomized clinical trials (RCTs). These side effects may be mediated by alterations of the gut microbiome. Whilst the impact of the human rectal and vaginal microbiome on HIV prevention has been highly investigated among women, less is known about its effect among men having sex with men (MSM), a vulnerable population at high risk for HIV and disproportionately affected by HIV/AIDS. In the present paper, we will overview the effects of PrEP on the gut microbiota in MSM. Mining PubMed/MEDLINE, we identified three studies that have found significant changes affecting the gut microbiota. However, these shifts in the gut microbiome composition are variable, probably due to methodological differences, even though all studies reviewed in the present overview consistently report aberrations at the level of the gut microbiota. More data are needed, especially concerning the long-term side effects of PrEP: despite the studies included being a high-quality RCT, and two well-designed cross-sectional studies, evidence related to the impact of HIV PrEP on the gut microbiome in MSM is scarce and based on small populations. A better understanding of the interactions between the gut microbiota, sexual orientation/identity, and HIV prevention is expected to improve PrEP adherence and devise strategies to counteract PrEP-related side effects.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
- *Correspondence: Nicola Luigi Bragazzi,
| | - Rola Khamisy-Farah
- Clalit Health Services, Akko, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Christina Tsigalou
- Laboratory of Microbiology, Department of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Naim Mahroum
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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14
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Burns CM, Wyatt C. Real-world safety of pre-exposure prophylaxis for HIV. Lancet HIV 2022; 9:e225-e226. [PMID: 35271827 DOI: 10.1016/s2352-3018(22)00058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 02/21/2022] [Indexed: 11/21/2022]
Affiliation(s)
- Charles M Burns
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Christina Wyatt
- Division of Nephrology, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC 27701, USA.
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