Tenofovir disoproxil fumarate and COVID-19 outcomes in men with HIV

• Type of Material: Article
• Authors: Guilin Li, Harvard University; Lesley S. Park, Stanford University; Sara Lodi, Harvard University; Roger W Logan, Harvard University; Emily Jeanne Cartwright, Emory University; Lydia Aoun Barakat, Yale University; Juan P Casas Romero, Harvard University; Barbara A Dickerman, Harvard University; Christopher T Rentsch, Yale University; Amy C Justice, Yale University; Miguel A Hernan, Harvard University
• Language: English
• Date: 2022-07-15
• Publisher: Wolters Kluwer Health, Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): https://doi.org/10.1097%2FQAD.0000000000003314
• Title of Journal or Parent Work: AIDS
• Volume: 36
• Issue: 12
• Start Page: 1689
• End Page: 1696
• Keywords: COVID-19; antiretroviral therapy; SARS-CoV-2; tenofovir; HIV
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Objective: To compare the risk of COVID-19 outcomes by antiretroviral therapy (ART) regimens among men with HIV. Design: We included men with HIV on ART in the Veterans Aging Cohort Study who, between February 2020 and October 2021, were 18 years or older and had adequate virological control, CD4 count, and HIV viral load measured in the previous 12 months, and no previous COVID-19 diagnosis or vaccination. Methods: We compared the adjusted risks of documented SARS-CoV-2 infection, COVID-19-related hospitalization, and intensive care unit (ICU) admission by baseline ART regimen: tenofovir alafenamide (TAF)/emtricitabine (FTC), TDF/FTC, abacavir (ABC)/lamivudine (3TC), and other. We fit pooled logistic regressions to estimate the 18-month risks standardized by demographic and clinical factors. Results: Among 20,494 eligible individuals, the baseline characteristics were similar across regimens, except that TDF/FTC and TAF/FTC had lower prevalences of chronic kidney disease and eGFR <60mL/min. Compared with TAF/FTC, the estimated 18-month risk ratio (95% CI) of documented SARS-CoV-2 infection was 0.65 (0.43, 0.89) for TDF/FTC, 1.00 (0.85, 1.18) for ABC/3TC, and 0.87 (0.70, 1.04) for others. The corresponding risk ratios for COVID-19 hospitalization were 0.43 (0.07, 0.87), 1.09 (0.79, 1.48), and 1.21 (0.88, 1.62). The risk of COVID-19 ICU admission was lowest for TDF/FTC, but the estimates were imprecise. Conclusion: Our study suggests that, in men living with HIV, TDF/FTC may protect against COVID-19-related events. Randomized trials are needed to investigate the effectiveness of TDF as prophylaxis for, and early treatment of, COVID-19 in the general population.