SUPPLeX: appearance- and performance-enhancing Supplements Use in people on Pre-exposure ProphyLaXis

Abstract

Background: Men-who-have-sex-with-men (MSM) may experience more dissatisfaction with their body image compared to heterosexual men. The desire to be muscular has been linked with use of appearance- and performance-enhancing supplements (APES), including muscle-building supplements, steroids, and fat-burning products. APES use has been associated with potential health risks including serious liver and renal abnormalities. The purpose of this study was to describe the use and safety of APES among people attending the ambulatory pre-exposure prophylaxis (PrEP) clinic at Toronto General Hospital. Methods: All participants at least 18 years on tenofovir disoproxil fumarate/emtricitabine were included; pregnant subjects were excluded. Prospective cross-sectional survey was conducted between February 1, 2018 and September 30, 2018 to assess APES usage, and retrospective chart reviews were done to determine the rates of liver and renal abnormalities from January 1, 2016 to September 30, 2018. RUCAM and Naranjo scales were used to assess causality with liver and renal abnormalities, respectively. Descriptive statistics were expressed as percentages or medians. Categorical data were compared using the Chi Square Test or Fisher’s exact test as appropriate, whereas continuous data were analyzed using the Student T-Test or Mann-Whitney U Test as appropriate. Results: Among 50 participants (median 32 years, 52% Caucasian, 86% MSM), 72% reported lifetime APES use and 52% with recent (within the past 6 months) use (APES group). Only 28% had never used APES (non-APES group). APES and non-APES groups had similar rates of liver abnormalities (mostly Grade 1), but 2 (8%) APES participants experienced Grade 3-4 elevations compared to none in the non-APES group. Liver enzyme elevations were possibly associated with creatine (n = 4), whey protein (n = 3), steroids (n = 2), and other weight-loss supplements (n = 2). In the APES group, 12% had elevated serum creatinine (all stage 1) compared to none in the non-APES group. Whey protein (n = 2), creatine (n = 1), steroids (n = 1), and tenofovir disoproxil fumarate (n = 1) were possibly associated with renal abnormalities. Conclusions: APES usage among people on PrEP was high and possibly associated with liver and/or renal abnormalities. Increasing provider and consumer awareness of potential health risks of APES is encouraged to enhance safety.