Intracellular tenofovir-diphosphate concentrations in HIV pre-exposure prophylaxis users who underwent bariatric surgery

Document Type

Article

Publication Date

1-15-2025

Publication Title

HIV medicine

Abstract

OBJECTIVE: To measure concentrations of tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) among individuals taking tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC) or tenofovir alafenamide plus emtricitabine (TAF/FTC) who were scheduled to undergo or had already undergone bariatric surgery.

METHODS: We enrolled pre-exposure prophylaxis (PrEP) users attending clinics in Toronto or Ottawa who were undergoing or had undergone bariatric surgery. After participants completed a minimum of 7 days of consecutive PrEP dosing, we collected DBS samples immediately before they administered their next daily dose of PrEP. Participants who had already undergone bariatric surgery before enrolment provided a single sample at baseline only. One participant undergoing planned bariatric surgery provided samples preoperatively and on postoperative days 7, 28 and 84. TFV-DP was measured by liquid chromatography tandem mass spectrometry. We compared results against the population range TFV-DP at varying degrees of adherence and stratified by chronology of bariatric surgery, type of bariatric surgery and PrEP regimen.

RESULTS: Of seven eligible participants, all were gay, cis-gender men. Median age was 48 years (Q1-Q3: 44-51). Six participants underwent bariatric surgery before enrolment: four Roux-en-Y gastric bypass (RYGB) and two sleeve gastrectomy (SG). Four were taking TDF/FTC and two were taking TAF/FTC. All had therapeutic TFV-DP concentrations, except for one TDF/FTC participant who underwent SG. One participant taking TAF/FTC enrolled before receiving RYGB and displayed a slight decrease in TFV-DP over time, although all concentrations remained in the therapeutic range.

CONCLUSIONS: Tenofovir diphosphate concentrations were at or near therapeutic values in this small sample of men using oral PrEP who underwent RYGB or SG.

Medical Subject Headings

Humans; Male; Pre-Exposure Prophylaxis; HIV Infections/prevention & control; Bariatric Surgery; Adult; Adenine/analogs & derivatives/blood/administration & dosage; Middle Aged; Anti-HIV Agents/administration & dosage/pharmacokinetics/therapeutic use; Female; Tenofovir/administration & dosage; Organophosphates/blood; Emtricitabine/administration & dosage/therapeutic use; Chromatography; Liquid; Tandem Mass Spectrometry; bariatric surgery; emtricitabine; gastrointestinal absorption; pre‐exposure prophylaxis; tenofovir

PubMed ID

39812218

ePublication

ePub ahead of print

Volume

26

Issue

4

First Page

643

Last Page

649

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