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No Change in Kidney Function, Cholesterol Ratio,
or Weight When 60+ Group Switches to TAF
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17th European AIDS Conference, November 6-9, 2019, Basel
Mark Mascolini
Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) had no impact on kidney function, weight, or total-to-high-density lipoprotein (HDL) cholesterol ratio in a London group of HIV-positive people over 60 years old [1]. Total cholesterol rose slightly after the switch to TAF in this 279-person study.
Some research indicates lipid gains when people trade TDF for TAF. At the same time that switch eases markers of kidney impairment and bone loss. Clinical researchers at Guy's and St. Thomas Hospital in London reviewed medical records to assess how switching to TAF affects kidney function, lipids, and weight in HIV-positive people over 60 years old.
The Guy's and St. Thomas team retrospectively reviewed records of people older than 60 attending their HIV clinic in 2017, noting estimated glomerular filtration rate (eGFR, a kidney function measure), lipid profiles, and body weight. They considered four groups of people with HIV: those who (1) stayed on a TDF-containing regimen, (2) switched from TDF to a TAF regimen, (3) switched from a non-TDF regimen to a TAF regimen, and (4) took neither TDF nor TAF during the study period. They charted changes from a baseline visit (before the TAF switch or the last 2017 visit in non-TAF takers) to the most recent visit 6, 12, and 18 months later.
Among the 56 people who stayed on TDF, age averaged 66, 36% were black and 54% white, and 82% were men. Among the 135 participants who changed from TDF to TAF, age averaged 68, 30% were black and 61% white, and 79% were men. Among the 29 people switching from a non-TDF regimen to TAF, age averaged 67, 45% were black and 48% white, and 69% were men. And among the 59 people taking neither TDF nor TAF, age averaged 67, 39% were black and 49% white, and 68% were men.
Compared with people who remained on a TDF regimen, the other three groups had no significant change in average eGFR, average total-to-HDL cholesterol ratio, or average body weight. Total cholesterol fell by an average 0.0963 mmol/L (3.7 mg/dL) in the group that stayed on TDF while rising an average 0.1754 mmol/L (6.8 mg/dL) in the group that switched from TDF to TAF (P < 0.0001). That difference remained significant after statistical adjustment for age, ethnicity, third antiretroviral in the regimen, and use of lipid-lowering therapy. Change in total cholesterol over time did not differ significantly between the third or fourth comparison group and the TDF-maintenance group.
Body weight change was not associated with switching to TAF after adjustment for integrase inhibitor use, age, gender, ethnicity, and sexual orientation.
Reference
1. Lee MJ, Tyler S, Ryan F, et al. The real-world impact of switching to tenofovir-alafenamide (TAF) on metabolic co-morbidities in PLWH aged over 60s. 17th European AIDS Conference, November 6-9, 2019, Basel. Abstract PE2/42.
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