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Lipid changes due to tenofovir alafenamide are reversible by switching back to tenofovir disoproxil fumarate

Milinkovic, Anaa; Berger, Florianb; Arenas-Pinto, Alejandroc,d; Mauss, Stefanb

doi: 10.1097/QAD.0000000000002350

Objective: The aim of the present study is to assess the effect of tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF) on lipids in patients switching from TDF to TAF and back.

Methods: Retrospective data collection on patients who were initially switched from TDF to TAF and switched back to TDF after generics of TDF became available.

Results: In total 385 patients were included. Median duration of TDF exposure before switch was 317 weeks (IQR 172–494). After switching from TDF to TAF mean total cholesterol (TC) increased from 186 ± 37 mg/dl at baseline to 206 ± 43 mg/dl and 204 ± 43 mg/dl at weeks 12 and 24 (p < 0.001). The increase in TC was mainly due to an increase in LDL-cholesterol. However ratio of TC/HDL remained unchanged indicating a simultaneous rise of LDL and HDL cholesterol. Baseline triglycerides increased from mean 153 ± 96 mg/dl to 176 ± 120 mg/dl and 176 ± 124 mg/dl at week 12 and 24 (p < 0.001). From 385 patients 168 were switched back from TAF to TDF after median duration on TAF of 96 weeks (IQR 89–104). At switching back from TAF to TDF mean TC was 202 ± 40 mg/dl and decreased at week 12 and 24 to 183 ± 41 mg/dl and 185 ± 35 mg/dl (p < 0.001). Mean triglycerides were 163 ± 119 mg/dl and decreased to 145 ± 108 mg/dl and 157 ± 112 mg/dl, respectively (p < 0.05). Patients with higher increases in TC after switching from TDF to TAF also showed more pronounced decreases after switching back.

Conclusions: The results demonstrate a reversible effect on lipids of switching from TDF to TAF and back.

aChelsea and Westminster Hospital, London, United Kingdom

bCenter for HIV and Hepatogastroenterology, Düsseldorf, Germany

cInstitute for Global Health, University College London, UK

dMedical Research Council Clinical Trials Unit at University College London, London, UK.

Correspondence to Stefan Mauss, Center for HIV and Hepatogastroenterology Humboldt Strasse 18; 40237 Duesseldorf, Germany;. E-mail:

Received 28 May, 2019

Revised 18 July, 2019

Accepted 22 July, 2019

Copyright © 2019 Wolters Kluwer Health, Inc.