Weight, anthropometric and metabolic changes after discontinuing antiretroviral therapy containing tenofovir alafenamide (TAF) in people living with Human Immunodeficiency Virus (HIV). Clinical Infectious Diseases
Managing obesity and cardiovascular disease has become an important aspect of clinical care in people with HIV (PWH). Concerns over antiretroviral therapy (ART) related weight gain, particularly with tenofovir alafenamide (TAF), prompted Damas et al. to investigate the reversibility of weight and metabolic changes after stopping TAF-based therapy among participants from the Swiss HIV Cohort Study.
The study included 6’555 participants who received TAF-based ART for at least six months between January 2016 and March 2023. Participants who discontinued TAF switched to either tenofovir disoproxil fumarate (TDF)-containing ART, dolutegravir/lamivudine (DTG/3TC), long-acting cabotegravir/rilpivirine, or other TAF-free ART. The study found that stopping TAF led to significant weight decreases only in individuals who switched to TDF-containing ART (adjusted mean weight change of -1.89 kg after 12 months, 95% CI -2.76 to -1.01), whereas no substantial weight changes occurred after switching to DTG/3TC (-0.17 kg, -0.82 to 0.84), CAP/RPV (-0.64 kg,-2.16 to 0.89 ), or other ART regimens (0.16 kg, -0.71 to 1.02). Additionally, stopping TAF resulted in decreased total cholesterol, triglycerides, and total cholesterol-HDL ratio, primarily driven by switches to TDF or DTG/3TC regimens.
In conclusion, replacing TAF with TDF in PWH leads to weight loss and improved lipid profiles, offering a potential strategy for managing ART-induced obesity. However, these benefits must be balanced against the improved safety profile of TAF compared to TDF, which includes improvements in renal function and lower rates of bone demineralization.