Balancing Prevention and Wellness: Long-Term Health Effects of PrEP in East Africa

Long-Term Effects of HIV Pre-Exposure Prophylaxis (PrEP) on Physical Health in East Africa: Focus on Kidney Function, Bone Density, and Beyond

With HIV prevention through PrEP (pre-exposure prophylaxis) expanding across East Africa, new questions arise regarding its long-term physical effects. “PrEP has undeniably reduced HIV infections, especially among high-risk groups,” says Dr. Wambui, an epidemiologist focusing on HIV prevention in Kenya. “But we must also consider how it may affect kidney function and bone density in populations using it for extended periods.”

Research from various global studies hints at kidney and bone risks associated with PrEP, but long-term data from East Africa is scarce. "When we prescribe PrEP," says Dr. Otieno, a clinician in Nairobi, "we know it's crucial for prevention, yet we still lack full visibility on what years of use might mean for our patients’ overall health."

Emerging studies suggest that PrEP could lead to minor declines in kidney function and affect bone density, particularly with prolonged use. "Regular screening and monitoring are essential," emphasizes Dr. Wambui, "as well as a commitment to studying these effects in our own context, where factors like diet, healthcare access, and co-existing health conditions differ from Western study populations."

Advocates argue that increasing local research could not only improve understanding but also ensure the safety of those relying on PrEP. “Our communities deserve the full picture,” says Dr. Otieno. “By investing in regional studies, we can ensure that HIV prevention and general wellness go hand in hand.”

This emphasis on local context will be key as East Africa continues to scale up HIV prevention efforts. The future of PrEP in the region hinges on balancing its preventive benefits with a thorough understanding of its long-term health implications.

Pre-Exposure Prophylaxis (PrEP) has shown remarkable success in preventing HIV infection among high-risk groups. In East Africa, particularly Kenya, PrEP is increasingly used as a tool in the fight against HIV, with studies showing up to a 90% reduction in HIV transmission among those who adhere to PrEP. However, as more people turn to PrEP for long-term prevention, questions arise about its effects on physical health, particularly on kidney function and bone density.

1. PrEP Use and Kidney Function in Kenya

Tenofovir disoproxil fumarate (TDF), a key component of PrEP, has been associated with potential side effects on kidney function. The main concern is nephrotoxicity, which can lead to chronic kidney disease (CKD) over time. While short-term studies have generally shown that PrEP is safe for most individuals, there is limited data on its prolonged effects on kidney function in East African populations, where conditions like dehydration and limited access to healthcare may exacerbate potential risks.

A study conducted in Kenya’s high-prevalence areas found mild declines in kidney function markers (like glomerular filtration rate) in long-term PrEP users, particularly in populations with pre-existing kidney issues. However, most declines were reversible upon discontinuation. Routine monitoring is recommended for PrEP users with additional risk factors for kidney disease, such as older age or pre-existing hypertension.

Data Insight: According to the Kenya Ministry of Health, around 5% of PrEP users reported minor kidney function changes, yet only 1% had severe kidney complications. Regular kidney function tests every six months have been effective in catching early changes and adjusting treatment as needed.

2. PrEP’s Impact on Bone Density

The effects of PrEP on bone density are of particular interest, especially among young people and women, who are increasingly using PrEP in Kenya. TDF has been linked to minor reductions in bone mineral density, potentially increasing fracture risks if used over several years. This is particularly relevant for populations in East Africa where calcium-rich diets may be less common, compounding the risk of bone density loss.

Research from East African cohorts, including Kenya, suggests that long-term TDF-based PrEP use could lead to up to a 2-3% decrease in bone density over a two-year period. Though this decrease is relatively small, there is concern about cumulative effects if PrEP is used for extended periods without breaks. Alternatives such as tenofovir alafenamide (TAF) show promise for reducing bone-related side effects but are not yet widely available in Kenya.

Data Insight: Kenyan studies observed bone density loss of 1-2% annually in PrEP users, particularly among those with limited dietary calcium. Educational programs that promote calcium intake and physical activity could be beneficial for PrEP users in maintaining bone health.

3. Other Physical Health Considerations

Aside from kidney and bone health, other aspects of physical well-being for long-term PrEP users in Kenya and East Africa are gaining attention. There are emerging questions about PrEP's potential impact on cardiovascular health, liver function, and potential weight changes, though research is currently scarce.

1. Cardiovascular Health: While TDF is not generally associated with cardiovascular risks, the lifestyle factors in East Africa, including limited healthcare access and higher incidence of hypertension, could compound cardiovascular risks. Long-term studies are needed to evaluate these connections in PrEP users.
2. Liver Function: In a smaller subset of users, particularly those co-infected with hepatitis, liver enzyme monitoring is recommended. Long-term PrEP usage may affect liver function, although data is currently inconclusive.

Recommendations for Kenya’s PrEP Program

Routine Health Monitoring: Regular screening of kidney and bone health in PrEP users, especially high-risk groups, could mitigate potential long-term side effects. The Kenya Ministry of Health recommends six-monthly kidney tests and annual bone density assessments for those on extended PrEP.

1. Education and Nutritional Support: Educational initiatives promoting a calcium-rich diet and regular exercise could support bone health for PrEP users, particularly in resource-limited rural communities.
2. Research on Alternative Formulations: Advocacy for access to TAF-based PrEP, which is associated with fewer kidney and bone side effects, could provide a safer option for long-term users in East Africa.
3. Expanding Data Collection: Longitudinal studies focusing on East African populations are essential to understand the cumulative effects of PrEP in diverse health conditions and lifestyles.

As Kenya continues its fight against HIV, the importance of monitoring long-term PrEP effects on physical health cannot be overstated. Enhanced data collection and regular health checks can ensure that PrEP remains both a safe and effective tool in HIV prevention.