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

ABSTRACT

Appearance- and performance-enhancing supplements (APES) may be associated with liver and renal toxicity, but use is often under-reported. This study describes the use and safety of APES among gay, bisexual, and other men-who-have-sex with men (gbMSM) attending an urban HIV pre-exposure prophylaxis (PrEP) clinic. A cross-sectional study was conducted between February 2018 to September 2018 to assess APES usage in gbMSM taking daily tenofovir disoproxil fumarate/emtricitabine for PrEP. Renal and liver function were assessed from electronic medical records. Among 50 participants (98% male, median 32 years, 52% White, on PrEP for a median 4.4 years), 72% reported lifetime APES use, with 52% currently using APES (median 1.5 products/person) and 28% never used APES. The most common products included whey protein, creatine supplements and anabolic steroids. The primary reason for APES use was to increase muscle mass. Three (12%) current APES users had elevated serum creatinine (stage 1) versus zero (0%) in the non-APES group. Two (8%) current APES users experienced grade 3–4 ALT/AST elevations versus zero (0%) in the non-APES group. APES usage among gbMSM taking PrEP was high and may be associated with liver/renal lab abnormalities. Increased awareness of APES use and potential toxicity is encouraged to enhance safety.

KEYWORDS:

• HIV
• PrEP
• supplement
• anabolic steroids
• toxicity

Acknowledgements

The authors gratefully thank Reina Bendayan, Andre Bonnici, Sylvie Carle, Joe Cox, Olavo Fernandes, Laura Murphy, Cindy Natsheh, Irving Salit, and Gary Wong for their useful suggestions on the development of the initial protocol, amendments, recruitment process, and data analysis. We would also like to thank Sasha Farina, Kuo-En Huang, Mona Omran, Superna Ramesh, and Ashley Sharifara on their assistance with the participant recruitment.

Disclosure statement

AT has received speaker and consultant honoraria from Abbvie, Gilead, Merck, and ViiV Healthcare. NS has received speakers or consultant honoraria and research grants for other studies from Gilead, Bristol-Myers Squibb, Merck, and ViiV HealthCare. IIB has consulted to BlueDot, a social benefit corporation that tracks emerging infectious diseases, and to the NHL Players' Association.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.