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3 New Papers on Integrase Inhibitors &
TAF and Weight Changes, Metabolics
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Download the PDF
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In conclusion, replacing TAF with TDF in PWH led to a decrease in body weight, whereas switching to other common TAF-free regimens such as DTG/3TC or CAB/RPV did not lead to substantial weight changes. These findings provide evidence to guide shared decision-making with patients affected by ART-induced overweight or obesity. The potential weight and metabolic benefits of replacing TAF with TDF must be weighed against the safety profile of TAF, which includes improvements in renal function among individuals with chronic kidney disease, and lower rates of bone demineralization[23-26]. Further studies are needed to assess whether these weight changes are sustained over time, and whether they have an impact on the incidence of weight-related cardiometabolic comorbidities among PWH.
CONCLUSIONS
The gain in weight seen in those treated with DTG, BIC, and/or TAF in clinical trials, observational studies, and clinical practice have led to a perception that these agents cause an excessive increase in weight. These observations have led some clinicians to consider alternative antiretrovirals as initial therapy or a switch regimen as a strategy to avoid or reverse excess weight gain. However, a comprehensive examination of major clinical trials suggest TDF-based regimens, in particular when given with EFV, attenuate weight gain, while DTG, BIC, and TAF can be considered neutral and not a cause of excessive weight gain. Given the efficacy and safety advantages of DTG, BIC, and TAF-based regimens, it is imperative that their associations with unexpected, undesired, or unhealthy increases in weight be rigorously evaluated before being accepted as causal.
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