Prevalence of renal and bone risk factors among individuals prescribed oral pre-exposure prophylaxis for HIV

• Published in: IJID regions 2023-03, Vol.6, p.68-75
• Main Authors: Fields, Sheldon D., Gruber, Joshua, Clue, Jamaal, Rey, Gabriel Gomez, Cuervo, Helena Díaz
• Format: Article
• Language: English
• Subjects: Emtricitabine/tenofovir alafenamide; Emtricitabine/tenofovir disoproxil fumarate; F/TAF; F/TDF; Kidney risk factor; Original Report; PrEP
• ISSN: 2772-7076; 2772-7076
• DOI: 10.1016/j.ijregi.2023.01.004

•Nearly half of individuals who were prescribed pre-exposure prophylaxis (PrEP) had both renal and bone risk factors.•A majority had at least one risk factor for renal (62%) or bone (68%) problems.•Excluding age as a risk factor, 46% had renal and 56% had bone risk factors.•The prevalence of existing renal and bone risk factors in this population was found to be high.•Renal and bone risk factors are important in choosing an appropriate PrEP regimen. The only available oral pre-exposure prophylaxis (PrEP) regimens approved in the United States to prevent HIV infection during the period covered by this study were emtricitabine/tenofovir alafenamide (F/TAF) and emtricitabine/tenofovir disoproxil fumarate (F/TDF). Both agents have similar efficacy, however F/TAF exhibits improved bone and renal health safety endpoints over F/TDF. In 2021, the United States Preventive Services Task Force recommended individuals have access to the most medically appropriate PrEP regimen. To understand the impact of these guidelines, the prevalence of risk factors to renal and bone health was evaluated among individuals prescribed oral PrEP. This prevalence study utilized the electronic health records of people prescribed oral PrEP between January 1, 2015 and February 29, 2020. Renal and bone risk factors (age, comorbidities, medication, renal function, and body mass index) were identified using International Classification of Diseases (ICD) and National Drug Code (NDC) codes. Among 40 621 individuals prescribed oral PrEP, 62% had ≥1 renal risk factor and 68% had ≥1 bone risk factor. Comorbidities were the most frequent (37%) class of renal risk factors. Concomitant medications were the most prominent (46%) class of bone-related risk factors. The high prevalence of risk factors suggests the importance of their consideration when choosing the most appropriate regimen for individuals who may benefit from PrEP.