Increased weight gain with HIV-therapy TAF medication

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 Research team Inselspital and therefore the University of Bern found an above-average weight gain related to increasing blood lipids after switching HIV-therapy from TDF to TAF. Additional individual counseling is going to be necessary to avoid harm after the therapy switch.


In Switzerland about 17,000 people live with an HIV infection, worldwide there are about 38 million. Today, the disease is often treated so successfully that standard life is often ensured to an excellent extent. However, weight increases are often observed at the start of HIV therapy thanks to adaptations of the metabolism, which are a part of successful therapy. Therefore, weight control plays a crucial role in HIV therapy. it's important, for instance, to avoid metabolic problems which will cause heart attacks or diabetes over the future.

Tenofovir is that the drug used as a part of quality HIV therapies. The previously, widely used TDF-based therapy (tenofovir disoproxil fumarate, TDF) has been related to renal side effects and bone loss. it had been therefore steadily replaced with a replacement variant, TAF-based therapy (tenofovir alafenamide), which was related to fewer side effects. The study presented here explores evidence of excessive weight gain after switching from TDF to TAF.

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TAF results in disproportionate weight gain

The key finding of the study shows that individuals who switched to TAF therapy gained significantly more weight (1.7 kg) than individuals who remained on TDF therapy (0.7 kg) during the observed 18 months. This effect was seen altogether subgroups of the study and independent of previous medication. within the group with a traditional BMI, 13.8% became overweight or obese with TAF, compared with 8.4% receiving TDF. At an equivalent time, a negative development of lipid metabolism was noted, with an overall increase in blood lipid levels. Lead author Bernard Serial notes: "The result was very consistent. Cardiovascular complications are the number one explanation for illness and death in people with HIV. Accordingly, the metabolic changes found are of great significance."

Extensive study

The multicenter cohort study included 4375 participants of the Swiss HIV Cohort Study who had been treated with a TDF-based therapy for a minimum of 6 months before the beginning of the study. Swiss university hospitals, other hospitals, and personal practices were involved. The central research question focused on the matter of determining the change in weight and fat levels induced by switching from TDF to TAF.

The study also addressed the question of whether diabetes would be diagnosed more often with TAF. However, no clear answer might be found here, because the period of time of 18 months for the study was probably too short.

The study was administered as a part of a bigger project examining the various aspects of switching from TDF to TAF. The research group has already reported on the event of renal function after switching from TDF to TAF (Changes in Renal Function After Switching From TDF to TAF in HIV-Infected Individuals: A Prospective Cohort Study).

What do these results mean for practice?

TAF is now a part of the foremost commonly used HIV therapies with excellent efficacy and tolerability. The study now shows that increased attention must be paid to the matter of weight gain when switching to TAF. rather than an unconditional, automatic switch from TDF to TAF, the benefits of higher renal tolerance and avoidance of bone loss must be balanced against the disadvantages of weight gain and increased blood lipid levels within the future. Individual counseling is often wont to develop optimal patient-specific solutions.

Impact on patient care, guidelines, and upcoming studies

Research into the long-term effects of HIV therapies on weight and blood lipid metabolism may be a high priority in HIV medicine. Prof. Andri Rauch, head of the study, therefore notes: "With its sizable amount of participants, the many results of our study for patient care helps both within the individual counseling of individuals with HIV and within the optimization of the international HIV guidelines. within the future, more in-depth studies are going to be necessary to research the precise mechanisms of the metabolic changes and particularly their effects (heart attacks, diabetes, etc.). Needless to mention, the search also continues for brand spanking new drugs which will ensure successful HIV therapy without negative effects within the future ."

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