Metabolic changes with tenofovir alafenamide vs TDF

Abstract

In patients receiving antiretroviral (ART) therapy for HIV infections, switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) is associated with adverse metabolic changes, according to study results reported in the Annals of Internal Medicine. The study used data from the Swiss HIV Cohort Study (SHCS) to assess metabolic parameters in people living with HIV (PLWH) receiving stable ART therapy who either switched to TAF (n=3484) or continued TDF (n=891). Median PLWH age was 50 years; 25.9% were female, and 51.7% had a normal body mass index (BMI) at baseline. After a median of three follow-up visits, switching to TAF was associated with a greater adjusted mean weight increase compared with remaining on TDF (1.7kg vs 0.7kg). Subgroup analysis revealed greater weight increases regardless of sex, origin, or other ART drugs used. Of those with a normal BMI at baseline, a greater proportion of TAF recipients became overweight or obese (13.8% vs 8.4%). However, there was no evidence that switching from TDF to TAF increased incidence of diabetes among individuals with a higher BMI at the index visit , note the authors. Switching to TAF was associated with increases in mean total cholesterol (9.5 mg/dL), HDL cholesterol (1.9 mg/dL), LDL cholesterol (4.7 mg/dL) and triglycerides (16.1 mg/dL). In contrast, remaining on TDF was associated with decreased total cholesterol and LDL cholesterol levels. Initiation of a new lipid-lowering treatment regimen occurred in 3.6% vs 3.4% of PLWH. Weight increases after switching from TDF to TAF should also be explored in large-scale randomized controlled trials with sufficient follow-up , suggest the authors, who add that the decision to prefer TAF over TDF as a component of ART should be individualized and accompanied by the repeated assessment of cardiometabolic risk factors .