Weight and Metabolic Changes After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in People Living With HIV : A Cohort Study.

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  • Additional Information
    • Corporate Authors:
      Swiss HIV Cohort Study
    • Source:
      Publisher: American College of Physicians--American Society of Internal Medicine Country of Publication: United States NLM ID: 0372351 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1539-3704 (Electronic) Linking ISSN: 00034819 NLM ISO Abbreviation: Ann Intern Med Subsets: MEDLINE
    • Publication Information:
      Publication: <2001->: Philadelphia, PA : American College of Physicians--American Society of Internal Medicine
      Original Publication: Philadelphia [etc.] American College of Physicians.
    • Subject Terms:
      Alanine/*therapeutic use ; Anti-HIV Agents/*therapeutic use ; HIV Infections/*drug therapy ; Lipids/*blood ; Tenofovir/*analogs & derivatives ; Tenofovir/*therapeutic use ; Weight Gain/*drug effects; Adult ; Alanine/adverse effects ; Anti-HIV Agents/adverse effects ; Blood Glucose/metabolism ; Cholesterol/blood ; Cholesterol, HDL/blood ; Cholesterol, LDL/blood ; Female ; HIV Infections/blood ; Humans ; Male ; Middle Aged ; Obesity/chemically induced ; Sensitivity and Specificity ; Tenofovir/adverse effects ; Triglycerides/blood
    • Abstract:
      Background: Tenofovir-based antiretroviral therapy (ART) has become first-line in all major HIV treatment guidelines. Compared with tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF) has a favorable renal and bone safety profile, but concerns about metabolic complications remain.
      Objective: To assess weight changes, the development of overweight/obesity, and changes in lipid levels 18 months after replacing TDF with TAF.
      Design: Cohort study.
      Setting: 5 university hospitals, affiliated hospitals, and private physicians in Switzerland.
      Participants: 4375 adults living with HIV who received TDF-containing ART for 6 months or longer.
      Measurements: Changes in weight and lipid levels were assessed using mixed-effect models. Differences in proportions of newly overweight/obese participants were calculated using 2-proportions Z tests.
      Results: 4375 individuals were included, with follow-up between 1 January 2016 and 31 July 2019. Median age was 50 years (interquartile range, 43 to 56 years), 25.9% were female, and 51.7% had a normal body mass index (BMI); 3484 (79.6%) switched to TAF and 891 (20.4%) continued TDF. After 18 months, switching to TAF was associated with an adjusted mean weight increase of 1.7 kg (95% CI, 1.5 to 2.0 kg), compared with 0.7 kg (CI, 0.4 to 1.0 kg) with the continued use of TDF (between-group difference, 1.1 kg [CI, 0.7 to 1.4 kg]). Among individuals with a normal BMI, 13.8% who switched to TAF became overweight/obese, compared with 8.4% of those continuing TDF (difference, 5.4 percentage points [CI, 2.1 to 8.8 percentage points]). Switching to TAF led to increases in adjusted mean total cholesterol (0.25 mmol/L [9.5 mg/dL]), high-density lipoprotein cholesterol (0.05 mmol/L [1.9 mg/dL]), low-density lipoprotein cholesterol (0.12 mmol/L [4.7 mg/dL]), and triglyceride (0.18 mmol/L [16.1 mg/dL]) levels after 18 months.
      Limitation: Short follow-up, small subgroup analyses, and potential residual confounding.
      Conclusion: Replacing TDF with TAF is associated with adverse metabolic changes, including weight increase, development of obesity, and worsening serum lipid levels.
      Primary Funding Source: Swiss National Science Foundation.
    • Contributed Indexing:
      Investigator: K Aebi-Popp; A Anagnostopoulos; M Battegay; E Bernasconi; J Böni; DL Braun; HC Bucher; A Calmy; M Cavassini; A Ciuffi; G Dollenmaier; M Egger; L Elzi; J Fehr; J Fellay; H Furrer; CA Fux; HF Günthard; D Haerry; B Hasse; HH Hirsch; M Hoffmann; I Hösli; M Huber; CR Kahlert; L Kaiser; O Keiser; T Klimkait; RD Kouyos; H Kovari; B Ledergerber; G Martinetti; B Martinez de Tejada; C Marzolini; KJ Metzner; N Müller; D Nicca; P Paioni; G Pantaleo; M Perreau; A Rauch; C Rudin; AU Scherrer; P Schmid; R Speck; M Stöckle; P Tarr; A Trkola; P Vernazza; G Wandeler; R Weber; S Yerly
    • Accession Number:
      0 (Anti-HIV Agents)
      0 (Blood Glucose)
      0 (Cholesterol, HDL)
      0 (Cholesterol, LDL)
      0 (Lipids)
      0 (Triglycerides)
      97C5T2UQ7J (Cholesterol)
      99YXE507IL (Tenofovir)
      EL9943AG5J (tenofovir alafenamide)
      OF5P57N2ZX (Alanine)
    • Publication Date:
      Date Created: 20210315 Date Completed: 20210804 Latest Revision: 20210804
    • Publication Date:
      20240829
    • Accession Number:
      10.7326/M20-4853
    • Accession Number:
      33721521