by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

September 27, 2022

Featured Literature:
Nhean S, Tseng A, Sheehan NL, Bogoch II.  Use and safety of appearance and performance enhancing supplements in gay, bisexual, and other men who have sex with men receiving daily tenofovir disoproxil fumarate/emtricitabine as HIV pre-exposure prophylaxis.  AIDS Care.  2022 Sept 14: 1-7.  doi:10.1080/09540121.2022.2121958.  PMID 36102034.  

This cross-sectional study evaluated the use and safety of appearance- and performance-enhancing supplements among gay, bisexual, and other MSM (gbMSM) receiving PrEP services in Toronto.  Adult participants on FTC/TDF completed a survey querying reasons for supplement use, type (e.g., muscle-building supplements, anabolic androgenic steroids, fat-burning products), frequency, cost, and factors which would impact the decision to discontinue supplements.  Participants were then included in a retrospective chart review comparing lab abnormalities among people who had never been exposed to these supplements vs. participants who used supplements at least weekly within 6 months.  Analyses included data on 50 participants (median 4.4yrs on PrEP, and 76% reported alcohol consumption).  52% reported supplement use within 6 months; median number of products used per person was 1.5.  The most commonly used products included whey protein (84.6%), creatine supplements (34.6%) and anabolic steroids (23.1%).  35% of participants indicated they would stop product use if they experienced mild side effects and 12% would stop only if they experienced major side effects.  12% of current product users had elevated serum creatinine (stage 1) vs. 0% in the non-use group.  8% of current product users experienced grade 3-4 ALT/AST elevations vs. 0% in the non-use group.  Among supplement users who experienced ALT/AST elevations, most continued their products while others discontinued only a portion.  No participants discontinued all products.

Author’s Commentary:

This study helps describe utilization patterns of appearance- and performance-enhancing supplements among gbMSM taking PrEP, as well as differences in serum creatinine and ALT/AST.  Although liver function tests are not routinely indicated for persons on oral PrEP, testing is still relatively common and abnormal results may lead to unnecessary concern regarding PrEP.  Further, although most people on F/TDF as PrEP will not experience renal toxicity, supplement co-use leading to serum creatinine elevations may affect oral PrEP decision-making.  For some individuals, PrEP services represent the single/main point of health care system contact—therefore, PrEP providers are well-positioned to share information on potential health risks of appearance- and performance-enhancing supplements.    

The author has no conflicts of interest to disclose.

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