Kai J Kauppinen¹ ², Inka Aho¹ ², Jussi Sutinen¹ ².

Affiliates

¹ Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital, Helsinki, Finland. ² University of Helsinki, Helsinki, Finland.

Abstract

Background: Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) increases low-density lipoprotein cholesterol (LDL-C) and body weight. Metabolic effects of the opposite TAF-to-TDF switch are unknown. The objective of this retrospective chart review study was to investigate the effect of TAF-to-TDF switch on plasma lipids, body weight, and atherosclerotic cardiovascular disease (ASCVD) risk score. ASCVD risk score was based on age, sex, race, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), systolic blood pressure, blood pressure lowering medication use, diabetes status, and smoking.

Methods: 146 patients with TAF-to-TDF switch (Switch group) were compared with 146 patients matched for gender, age, and third antiretroviral agent class who continued unchanged TAF-containing regimen (Control group). Data were collected at approximately 1 year (follow-up FU-1) and 2 years (follow-up FU-2) after baseline values.

Results: In Switch group at FU-1 TC and LDL-C decreased 12.1% and 12.4% (p<0.001 in both), respectively (Table 1). HDL-C also decreased 8.2% (p<0.001) in Switch Group, but TC/HDL-C ratio did not change. No statistically significant changes were observed in Control group in any lipid values. Creatinine and estimated glomerular filtration rate (eGFR) remained stable in both groups. TC remained similarly decreased through FU-2 in Switch group, but LDL-C increased from FU-1 to FU-2 in both groups (Figure 1). ASCVD risk score decreased from 6.3% at baseline to 6.0% at FU-2 (p=0.012) in Switch group but increased from 8.4% to 9.1% (p=0.162) in Control group. Body weight increased from 83.4 kg at baseline to 84.9 kg at FU-2 (p=0.025) in Control group but remained stable in Switch group (83.1 to 83.7 kg, p=0.978) (Table 2).

Conclusions: TAF-to-TDF switch improved plasma lipid profile and ASCVD risk score, as well as prevented weight gain, when compared with ongoing TAF-based antiretroviral therapy.

AIDS 2022, in press.