Spotlight Center on HIV Prevention Today

Weighing Risks of TDF/FTC PrEP Side Effects in People Without HIV

Winter 2012

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    17A. "Among those who discontinued tenofovir use, the time period following cessation was not significantly associated with either higher or lower risks of proteinuria (HR=1.05 per year, 95% CI: 0.93-1.18, p = 0.41) or rapid decline (HR=1.05 per year, 95% CI: 0.94-1.16, p=0.42), although there was a marginal association of time off tenofovir with [chronic kidney disease] (HR=1.22 per year, 95% CI: 0.99-1.50, p=0.055). All hazard ratios remained greater than unity, which suggests that the effects of tenofovir on kidney disease risk were not reversible following discontinuation."
  18. Bonjoch A, Echeverría P, Perez-Alvarez N, et al. High rate of reversibility of renal damage in a cohort of HIV-infected patients receiving tenofovir-containing antiretroviral therapy. Antiviral Res. 2012;96:65-69.
  19. Touzard Romo F, Livak B, Aziz M, et al. Recovery of renal function and virologic suppression following tenofovir discontinuation. Infectious Disease Society Association. San Diego. October 17-21, 2012.
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  24. Gallant JE, Staszewski S, Pozniak AL, et al. Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial. JAMA. 2004;292:191-201.
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  26. Campbell LJ, Ibrahim F, Fisher M, Holt SG, Hendry BM, Post FA. Spectrum of chronic kidney disease in HIV-infected patients. HIV Med. 2009;10:329-336.
  27. Gallant JE, Winston JA, DeJesus E, et al. The 3-year renal safety of a tenofovir disoproxil fumarate vs. a thymidine analogue-containing regimen in antiretroviral-naive patients. AIDS. 2008;22:2155-2163.
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  30. Wever K, van Agtmael MA, Carr A. Incomplete reversibility of tenofovir-related renal toxicity in HIV-infected men. J Acquir Immune Defic Syndr. 2010;55:78-81.
  31. Dauchy FA, Lawson-Ayayi S, de La Faille R, et al. Increased risk of abnormal proximal renal tubular function with HIV infection and antiretroviral therapy. Kidney Int. 2011;80:302-309.
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  33. Walker Harris V, Althoff K, Reynolds S, et al. Incident bone fracture in men with, or at risk for, HIV-infection in the Multicenter AIDS Cohort Study (MACS), 1996-2011. XIX International AIDS Conference. July 22-27, 2012. Washington, DC. Abstract MOPE086.
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  39. Yin MT, Lu D, Cremers S, et al. Short-term bone loss in HIV-infected premenopausal women. J Acquir Immune Defic Syndr. 2010;53:202-208.
  40. Yin MT, Shi Q, Hoover DR, et al. Fracture incidence in HIV-infected women: results from the Women's Interagency HIV Study. AIDS. 2010;24:2679-2686.
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  42. Thompson PW, Taylor J, Dawson A. The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dorset, UK. Injury. 2004;35:462-466.
  43. Bedimo R, Maalouf NM, Zhang S, Drechsler H, Tebas P. Osteoporotic fracture risk associated with cumulative exposure to tenofovir and other antiretroviral agents. AIDS. 2012;26:825-831.
  44. Jacobson DL, Spiegelman D, Knox TK, Wilson IB. Evolution and predictors of change in total bone mineral density over time in HIV-infected men and women in the Nutrition for Healthy Living Study. J Acquir Immune Defic Syndr. 2008; 49:298-308.
  45. Bonjoch A, Figueras M, Estany C, et al. High prevalence of and progression to low bone mineral density in HIV-infected patients: a longitudinal cohort study. AIDS. 2010;24:2827-2833.
  46. McComsey GA, Kitch D, Daar ES, et al. Bone mineral density and fractures in antiretroviral-naive persons randomized to receive abacavir-lamivudine or tenofovir disoproxil fumarate-emtricitabine along with efavirenz or atazanavir-ritonavir: AIDS Clinical Trials Group A5224s, a substudy of ACTG A5202. J Infect Dis. 2011;203:1791-1801.
  47. Callebaut C, Margot N, Stepan G, Tian T, Miller M. Virological profiling of GS-7340, a next-generation tenofovir prodrug with superior potency over TDF. 52nd Interscience Conference on Antimicrobials and Chemotherapy. September 9-12, 2012. San Francisco. Abstract H-552.
  48. Ruane P, DeJesus E, D Berger D, et al. GS-7340 25 mg and 40 mg demonstrate superior efficacy to tenofovir disoproxil fumarate 300 mg in a 10-day monotherapy study of HIV-1+ patients. 19th Conference on Retroviruses and Opportunistic Infections. March 5-8, 2012. Seattle. Abstract 103.
  49. Markowitz M, Zolopa A, Ruane P, et al. GS-7340 demonstrates greater declines in HIV-1 RNA than TDF during 14 days of monotherapy in HIV-1-infected subjects. 18th Conference on Retroviruses and Opportunistic Infections. February 27-March 2, 2011. Boston. Abstract 152LB.
  50. Babusis D, Phan TK, Lee WA, Watkins WJ, Ray AS. Mechanism for effective lymphoid cell and tissue loading following oral administration of nucleotide prodrug GS-7340. Mol Pharm. 2012 Jul 12. Epub ahead of print.
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Reader Comments:

Comment by: Cee (newport news,va) Thu., Sep. 29, 2016 at 4:23 pm UTC
your assuming simply because they chose to take prep they are on a collision course with hiv, I myself am on it simply as another safety measure because as we all know condoms are not 100% affective I don't want to be that 1 that gets caught in the minority...most of the people that i've talked to that have contracted hiv did so in a relationship they thought was monogomous
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Comment by: elton (uganda) Thu., Nov. 26, 2015 at 4:31 am UTC
How kidney diseases be controlled when taking prEP
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Comment by: Wendell (San Francisco, CA) Sat., Jul. 5, 2014 at 9:13 pm UTC
"By and large, people who put themselves on a collision course with HIV are not paragons of good health. Because people with the highest risk of picking up HIV during sex are those who have lots of sex -- often without condoms -- this group shoulders a high burden of other sexually transmitted infections, including hepatitis C virus (HCV) infection, an oftnoted risk factor for deliquescing bone density and chronic kidney disease. In the United States, young black men who have sex with men (MSM) account for a burgeoning proportion of new HIV infections,10 and blacks run a higher risk of kidney disease than whites. Young white and black MSM with lots of sex partners often have other habits that threaten their health -- smoking, drinking, and downing recreational drugs that range from the innocuous to the caustic. In the United States, WIHS findings and other data indicate, women with a high HIV risk are often poor, overweight, and members of minorities with off-andon access to health care."

The rest of this article is fairly free from editorializing and bias. This paragraph seems to brim with judgment. While it is not likely the author's conscious intent, this paragraph can readily be seen as suggesting that the proverbial bar is already set so low on the intended recipients of this therapy that they are not worthy of the same level of care. This can be very hurtful to groups who have traditionally been extremely marginalized by society. Since the next paragraph gives most of the same data in a much more clear and bias-free way, is this paragraph necessary at all? Is it worth the virtual paper it is figuratively printed on to take the extra time to say that PrEP is only for throw-away dregs of society?
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Replies to this comment:
Comment by: Steve (seattle) Sun., Oct. 5, 2014 at 10:06 am UTC
was going to say exactly the same thing. What a horrific editorial bias to slip into a medical paper.

Comment by: hananji (kenya) Thu., Dec. 19, 2013 at 3:35 am UTC
I think tdf cause poor distribution of fats in people living with hiv
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