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<\/h2>\n<\/h2>\nMark Mascolini, natap.org<\/span><\/strong><\/p>\n A 110-person retrospective study\u00a0found\u00a0increasing body mass index (BMI) and atherosclerotic cardiovascular disease (ASCVD) risk\u00a0after a\u00a0switch from tenofovir disoproxil fumarate (TDF) to\u00a0tenofovir alafenamide (TAF), even though participants changed no other drugs in their regimen. [1]<\/span><\/strong><\/p>\n Thomas\u00a0Jefferson\u00a0University\u00a0researchers said clinical implications could include the need to treat more people with statins\u00a0to\u00a0keep ASCVD risk in line.<\/span><\/p>\n Switching from TDF to TAF spares antiretroviral-treated people unwanted impacts on kidney and bone. But ongoing research indicates that trading TDF for TAF hurts cholesterol numbers and boosts weight, while the impact on ASCVD risk remains uncertain. To explore these issues,\u00a0Thomas\u00a0Jefferson researchers conducted a retrospective study to\u00a0assess\u00a0changes in BMI and ASCVD risk score when changing from TDF to TAF while maintaining other antiretrovirals in the regimen.<\/span><\/p>\n The analysis included\u00a040- to 75-year-old\u00a0adults who took a TDF-containing regimen for at least one year, during which they never had a viral load above 200 copies\/mL. Everyone replaced TDF with TAF without changing their other antiretrovirals and had one year of observation after the switch. In the year before and the year after the change, researchers calculated median BMI, weight, total cholesterol, ‘bad’ low-density lipoprotein (LDL) cholesterol, ‘good’ high-density lipoprotein (HDL) cholesterol, and triglycerides. Using 2018 American College of Cardiology\/American Heart Association guidelines, they figured ASCVD risk scores at the switch and 6 to 12 months afterwards. To assess changes in BMI and ASCVD risk score, the investigators used repeated measures generalised estimating equations.<\/span><\/p>\n The 110 study participants averaged 50 years\u00a0in age, 73% were men, 58% black, 34.5% white, 5.5% Hispanic, and 2% Asian. While 31% were normal weight, 4% were underweight, 28% overweight, and 37% obese. The group spent a median of eight years taking antiretrovirals. Almost half (49%) took an integrase inhibitor with TDF, while 29% took an NNRTI, 16% a PI, and the rest something else.<\/span><\/p>\n Median weight, BMI,\u00a0total and LDL cholesterol, and ASCVD risk score all climbed significantly after TAF replaced TDF: weight\u00a0185.4 to 190.5 lb (p<0.01), BMI 28 to 28.2 kg\/m2<\/sup>\u00a0(p<0.01), total cholesterol 173.8 to 195.0 mg\/dL\u00a0(p<0.01), LDL cholesterol 98.6 to 112.1 mg\/dL\u00a0(p<0.01), and ASCVD risk score 6.9% to 8.1%\u00a0(p<0.01). HDL cholesterol\u00a0and triglycerides\u00a0rose nonsignificantly and total-to-HDL cholesterol ratio did not change.<\/span><\/p>\n Regression analysis controlling for female sex linked switching from TDF to TAF\u00a0to a 0.45-kg\/m2<\/sup>jump in expected BMI. Regression analysis controlling for age, female sex, race, and time since HIV diagnosis\u00a0tied\u00a0swapping TDF for TAF\u00a0to\u00a0a 13%\u00a0boost\u00a0in expected ASCVD risk score.\u00a0<\/span><\/p>\n The Thomas Jefferson researchers argued it was unlikely that\u00a0rising\u00a0BMI represented a “return to\u00a0health” because participants had long-standing HIV infection well-controlled by antiretroviral therapy. Although observed BMI changes were small, the investigators added, they could have clinical relevance since even\u00a0small BMI changes can affect lifetime risk for diabetes and ASCVD. The 13% jump in ASCVD risk score, they noted, lifted more than half of the study group to scores that would require statin therapy.<\/span><\/p>\n Now that the FDA has cleared TAF\/FTC for preexposure prophylaxis, the findings could\u00a0also\u00a0have implications for steady PrEP users.<\/span><\/p>\n Reference<\/span><\/p>\n Mark Mascolini, natap.org A 110-person retrospective study\u00a0found\u00a0increasing body mass index (BMI) and atherosclerotic cardiovascular disease (ASCVD) risk\u00a0after a\u00a0switch from tenofovir disoproxil fumarate (TDF) to\u00a0tenofovir alafenamide (TAF), even though participants changed no other drugs in their regimen. [1] Thomas\u00a0Jefferson\u00a0University\u00a0researchers said clinical …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,3,8],"tags":[274],"class_list":["post-36709","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-antiretrovirals","category-side-effects","tag-idweek-2019"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/36709","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=36709"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/36709\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=36709"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=36709"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=36709"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
\nhttp:\/\/natap.org\/2019\/IDWeek\/IDWeek_48.htm<\/a> (natap report)<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"