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Over time, people with HIV who received Vemlidy instead of Viread as part of their antiretroviral therapy experienced weight gain and other negative metabolic changes, researchers reported in Annals of Internal Medicine.
Previous research has indicated that people living with HIV (PLWH) who switched from Viread (tenofovir disoproxil fumarate, Gilead Sciences; TDF) to Vemlidy (tenofovir alafenamide fumarate, Gilead Sciences; TAF) maintained virologic suppression with significant improvements in renal and bone safety. TAF has “become first-line in all major HIV guidelines,” the researchers noted.
Bernard Surial, MD, of the department of infectious diseases at Bern University Hospital and the University of Bern in Switzerland, and colleagues conducted a cohort study to assess weight changes, the development of overweight or obesity and changes in lipid levels after switching from TDF to TAF. They followed 4,375 PLWH in Switzerland from Jan. 1, 2016, through July 31, 2019. The patients’ median age at baseline was 50 years; 25.9% were women; and 51.7% had a normal BMI. All patients had received TDF-containing ART for at least 6 months — 79.6% ultimately changed their treatment to TAF, whereas the others stayed on TDF until the end of the study.
The researchers wrote that after 18 months, switching from TDF with TAF was associated with an adjusted mean weight increase of 1.7 kg (95% CI, 1.5-2) compared with 0.7 kg (95% CI, 0.4-1), with a between-group difference of 1.1 kg (95% CI, 0.7-1.4). Among PLWH with a normal BMI, 13.8% those who changed their therapy to TAF also became overweight/obese compared with 8.4% of those continued TDF (difference = 5.4 percentage points; 95% CI, 2.1-8.8). Switching to TAF also led to increases in adjusted mean total cholesterol (0.25 mmol/L), high-density lipoprotein cholesterol (0.05 mmol/L), LDL cholesterol (0.12 mmol/L) and triglyceride (0.18 mmol/L) levels after 18 months.
Surial said in a press release that “cardiovascular complications are a leading cause of illness and death in people with HIV. Accordingly, the metabolic changes found are of great significance.”