HIV and Chronic Hepatitis B Drug May Cause Hair Loss

There are many medications which can cause temporarily thinning hair as a side effect.

Where this is a known adverse event, it is listed on the patient information leaflet which accompanies the drug so that those taking it know what they could potentially expect.

Tenofovir alafenamide (TAF), a prescription medication used to treat HIV and chronic hepatitis B, has recently come under fire for seemingly causing hair loss in a number of cases, but failing to state this rare side effect on its warnings.

Recent studies show that this does appear to be a problem in some users who start using TAF, but note that it may only affect certain communities of people - notably, women of colour.

Six African-American women affected

Information on this potential oversight was published in the Oxford Academic journal, based on studies reported on the Open Forum Infectious Diseases July 2019 volume, and carried out by the Infectious Diseases Society of America.

It described six instances where African-American women aged between 40 and 61 years of age, started to experience hairloss that was 'focal and involved the scalp' after switching to TAF to treat HIV. This small case series all came from the same academic outpatient HIV practice located in Detroit, Michigan, USA.

The report states, 'Among the 2139 patients who followed up at this clinic in 2018, 579 were AA females (27%). Six HIV-infected AA females developed alopecia after switching from TDF - to TAF-containing regimens. All patients who tolerated TDF were switched to TAF because of its better long-term safety profile.'

It further detailed, 'One patient had patchy hair loss involving the back of the head . Time-to-onset of alopecia after switching to TAF ranged between 2 months and 1 year; however, 4 out of 6 patients reported hair loss after 24 months. No pain, pruritus, or tenderness was reported by any of the patients, and there was no evidence of scarring, flaking, or inflammation on physical examination.

All patients had sustained viral suppression at the time of evaluation, their CD4 T-lymphocyte (CD4) count (range) was persistently above 500 (6001312) cells/μL, and they had no clinical evidence of active infections. No metabolic derangements that would explain the alopecia were identified on basic metabolic panels, liver function tests, albumin, total protein, or thyroid-stimulating hormone levels. A complete blood count ruled out severe anaemia as the cause of alopecia in all patients.

A sexually transmitted disease (STD) workup including syphilis, chlamydia, and gonorrhea DNA amplification testing, hepatitis B surface antigen, hepatitis C antibodies, and a treponemal enzyme immunoassay was non-revealing.

No new medications other than TAF were introduced at the time of development of alopecia, and other medications that were already being taken by the patients were not known to be associated with alopecia. A detailed history and physical examination ruled out psychological distress, severe caloric restrictions, or changes in lifestyle habits (such as use of new shampoos and hair products) as the cause of hair loss.

One patient started braiding her hair following the alopecia, and another patient had been performing tight hair braiding for many years ; however, both reported alopecia only after switching to TAF.'

Further investigation is warranted

The repeated notes regarding tight hairstyles relate to the potential presence of an increasingly common hair loss condition which can be brought on by this type of styling, known as Traction Alopecia.

This is particularly common among women of colour as, not only are certain types of tautly braided hairstyles - often, as something of a misnomer, referred to as protective hairstyles - part of black culture, but Afro hair is naturally more brittle. This makes it more prone to breakage in addition to hair loss from the strain these punishing styles place on the follicles, especially around the hairline and temples.

One thing we noticed in this report is that, despite researchers advising none of the other medications these women were already taking were known to be associated with hair loss, some have been linked to increased hair shedding, albeit anecdotally.

One of these is Metformin, which is usually used to treat polycystic ovary syndrome (PCOS), which the 61 year old candidate was known to take. Another is lisinopril, a blood pressure medication, as taken by the 44 year old participant. Whilst the 42 year old participant is down as taking 'Ergocalciferol' which type is unknown. Vitamin A- Ergocalciferol is known to cause hair loss but this is a rare occurrence.  

However, two of the test subjects - one aged 45 and another aged 49, both listed the antihistamine cetirizine (Zyrtec) among the additional medication they took. This has previously been shown in limited clinical trials to increase hair growth when used topically, in cases of genetic hair loss (androgenetic alopecia, also known as Male Pattern Baldness or Female Pattern Hair Loss).

It is not just medication which can cause hair loss; sometimes having an underlying illness, or even an established health issue, can also cause shedding. Therefore, it is worth discussing your concerns with your doctor and arranging a panel of blood tests including those to check your iron and vitamin B12 levels plus your thyroid function and whether you have a condition such as diabetes or PCOS, as these can all cause diffusely thinning hair from all over the scalp.

This is due to a treatable condition known as Chronic Telogen Effluvium which can be brought on by a number of illnesses as a side effect - and certain medications.

Should these tests show nothing that would explain your hair loss, a consultation - either in person, or online - with a dedicated specialist may help to put your mind at rest. They can assess your scalp then provide tailored recommendations for a personalised hair loss treatment course based on their diagnosis and your medical profile, working in tandem with your healthcare team on any on-going issues connected to illness concerns, where possible.

Belgravia hair loss specialists certainly welcome additional investigation into any medications which are thought to cause hair loss so that this can be fully established and added to the patient information leaflet.

Given sudden-onset shedding - even if, in the case of Chronic (or mild) Telogen Effluvium it is actually triggered some three months before it presents - can be a source of such shock and concern to patients, any opportunity to prepare them for this possibility and how to deal with it if it does arise, is a positive step.