BACKGROUND: Daily oral pre-exposure prophylaxis (PrEP) with tenofovir alafenamide (TAF) is an alternative for tenofovir disoproxil (TDF) to prevent HIV infection. Studies showed that switching from TDF to TAF can worsen the lipid profile in people with HIV, which may increase statin initiation. However, there is a paucity of data regarding a possible association of TAF use and statin initiation among people on PrEP.
METHODS: Adults (= 18 years) initiating PrEP between 10/2019-06/2022 in Kaiser Permanente Southern California (KPSC) with no evidence of HIV infection, or abnormal renal, hepatic, and hematologic function were included. First filled PrEP prescription (TAF or TDF) while enrolled in KPSC during the study period and subsequent statin initiation within 2 to 24 months following PrEP initiation were ascertained through pharmacy dispensing data. Individuals initiating TAF were 1:4 matched to those initiating TDF using a propensity score informed by baseline demographics, cardiovascular risk score, smoking history, comorbidities, medical center, neighborhood deprivation index, and PrEP initiation year. Odds ratio (OR) and risk difference (RD) of statin initiation were estimated using logistic regression and g-computation, respectively. Missing covariates were handled with multiple imputation. A subgroup analysis was performed in individuals =40 years at PrEP initiation as statins were more likely to be prescribed in this age group.
RESULTS: We included 394 adults initiating TAF (mean age of 36 years, 99% male, 30% Hispanic, 42% non-Hispanic White, 7% non-Hispanic Black) and 1,576 matched adults initiating TDF. During the follow-up, 6 (1.5%) individuals initiated statins in those with TAF use while 11 (0.7%) individuals initiated statins in those using TDF. TAF use was associated with an increased statin initiation (OR: 2.3, 95%CI: 1.7-3.2; RD: 0.9%, 95%CI: 0.4-1.3%). Subgroup analysis among those =40 years revealed a more elevated likelihood of statin initiation among individuals with TAF use compared with those with TDF use (OR: 3.0, 95%CI: 1.9, 4.8; RD: 4.2%, 95%CI: 2.0-6.4%).
CONCLUSIONS: TAF use was associated with an increased statin initiation, especially among those =40 years at PrEP initiation. Studies with longer follow-up to evaluate clinical cardiovascular outcomes are warranted.

Download the e-Poster (PDF)