Preprint Review Version 1 Preserved in Portico This version is not peer-reviewed

A Reality We Have to Face in the Era of Tenofovir-Derived Pre-exposure Prophylaxis and Antiretroviral Therapy: A Paradigm Shift From the Reduction of HIV Risk to the Increased Risk of Cardiovascular Disease?

Version 1 : Received: 2 May 2022 / Approved: 5 May 2022 / Online: 5 May 2022 (16:11:31 CEST)

How to cite: Lew, J.; Yee, I. A Reality We Have to Face in the Era of Tenofovir-Derived Pre-exposure Prophylaxis and Antiretroviral Therapy: A Paradigm Shift From the Reduction of HIV Risk to the Increased Risk of Cardiovascular Disease?. Preprints 2022, 2022050051 (doi: 10.20944/preprints202205.0051.v1). Lew, J.; Yee, I. A Reality We Have to Face in the Era of Tenofovir-Derived Pre-exposure Prophylaxis and Antiretroviral Therapy: A Paradigm Shift From the Reduction of HIV Risk to the Increased Risk of Cardiovascular Disease?. Preprints 2022, 2022050051 (doi: 10.20944/preprints202205.0051.v1).

Abstract

The introduction of tenofovir-derived prodrugs has revolutionised the prevention and management of HIV, which has coincided with 23% reduction in new HIV incidences globally. To date, there are two formulations of tenofovir-derived nucleoside reverse transcriptase inhibitor (NRTI): tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) and tenofovir alafenamide fumarate/emtricitabine (TAF/FTC). Although these prodrugs have shown favourable safety profile, their effects on cardiovascular health are differ from one another: TDF/FTC exhibits potential lipid-lowering effect, TAF/FTC demonstrates potential lipid-inducing effect, which is a major risk factor for cardiovascular diseases. However, this issue has not been previously elucidated, especially among the marginalised populations [lesbian, gay, bisexual and transgender (LGBT) and men who have sex with men (MSM)] who are likely be the main users of these prodrugs. This is of clinically significance as the cardiovascular health in these populations is often overlooked, in addition to a lack of appropriate cardiovascular risk prediction algorithm. Therefore, this review aims to (1) highlight the cardiovascular risks of tenofovir-derived prodrugs in the marginalized populations, and also to (2) establish the importance of having a cardiovascular risk prediction model that is specific to this particular populations so that their health management could be more comprehensive.

Keywords

Tenofovir; Pre-exposure prophylaxis; anti-retroviral therapy; cardiovascular disease; LGBT

Subject

MEDICINE & PHARMACOLOGY, Pharmacology & Toxicology

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