“Good Truvada” isn’t so good.

Shocking news!

I was alerted to the following article, Type of HIV Pre-Exposure Prophylaxis Could Influence Cardiovascular Risk, which discusses the increase in cardiovascular events among patients taking TAF, which I like to call “good Truvada,” compared with patients taking TDF, or “bad Truvada.” The article explains how patients on “good Truvada” (TAF), compared to those on “bad Truvada” (TDF), have a higher risk of high blood pressure and of cholesterol levels that “need to be treated” with statin drugs.

(Yes, I know that Truvada is by definition a TDF-containing medication and that TAF is marketed under other brand names such as Descovy, so TAF isn’t technically “good Truvada.” I will continue using these terms because everyone knows what I mean when I use them, and they are highly descriptive.)

Regardless, from the article:

Research at Kaiser Permanente Southern California shows that some types of HIV pre-exposure prophylaxis (PrEP) therapy may have a better cardiovascular risk profile than others.

As reported in JAMA Network Open, use of tenofovir alafenamide fumarate (TAF) for HIV PrEP was linked to increased risk for high blood pressure and need for cholesterol lowering statin medication compared with tenofovir disoproxil fumarate (TDF).

We know already that cardiovascular events are over represented among the HIV-positive population. This is often explained as being due to “HIV disease” (do they just make up these names to confuse people? Does “HIV disease” have a definition beyond testing positive on a test not testing for a virus?); however, cardiovascular events have been among the adverse effects of “anti HIV” drugs since at least the advent of the protease inhibitor medications in the mid-1990s.

We also know that TDF has been under fire, especially regarding the adverse effects of kidney damage and bone necrosis/osteoporosis/osteopenia. TAF also causes these effects, potentially at a lower rate than does TDF (although not enough time may have passed to know for sure), but this new development is concerning.

Here are some clinical data:

Some earlier research suggested TAF PrEP may have a worse cardiovascular risk profile than TDF, which prompted Rivera and colleagues to investigate further.

They identified a group of 6824 eligible individuals aged 34 years on average, most of whom were male (97%), who were beginning HIV PrEP therapy.  From this group, two cohorts who did not have high blood pressure (n=5523) or who were not using statins (n=6149) when starting PrEP were created. In the first cohort, 371 were prescribed TAF PrEP and 1484 were prescribed TDF and in the second cohort 382 were prescribed TAF and 1473 TDF PrEP. People who were older and of non-Hispanic White ethnicity were more likely to be prescribed TAF than TDF PrEP.

The article closes with the following caution:

“TAF has been a welcome addition to the products for PrEP due to its benefits on kidney and bone health and smaller pill size,” write the authors.

“However, it may have unwanted impact on cardiometabolic health. Future studies with larger sample size and a longer follow-up period are warranted to provide more evidence to inform clinical decision-making regarding different PrEP regimens, especially among those with increased risk for cardiometabolic disease.”

If this storyline seems familiar, it should. The history of “anti HIV” medications is nothing but the approval and marketing of one drug after another that has caused life altering, and in some cases life ending, side effects; a new drug is introduced that is “so much better,” only to have reports of its serious adverse effects come out after a few years have passed. And in this case, it is even more ridiculous, because by prescribing these medications to HIV-negative individuals as PrEP, the medical community is exposing them to serious adverse effects for a condition that, even per the most mainstream of physicians, they show no indication of even having. Everyone in a so-called “risk group” ought to be livid, and extremely concerned at being targeted for a lifetime of toxic therapy.

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