Switching from tenofovir alafenamide to tenofovir disoproxil fumarate improves lipid profile and protects from weight gain

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. Objectives: To investigate the effect of TAF-to-TDF switch on plasma lipids, body weight, and atherosclerotic cardiovascular disease (ASCVD) risk score. Design: A retrospective chart review. Methods: One hundred and forty-six patients with TAF-to-TDF switch (Switch group) were compared with 146 patients matched for sex, 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, total cholesterol (TC) and LDL-C decreased 12.1% and 12.4% (P < 0.001 in both), respectively. High-density lipoprotein cholesterol (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. TC remained similarly decreased through FU-2 in Switch group, but LDL-C increased from FU-1 to FU-2 in both groups. 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 (83.1-83.7 kg, P = 0.978). 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.