scholarly journals Changes in Body Mass Index and Atherosclerotic Disease Risk Score After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Jason J Schafer ◽  
Kaitlin N Sassa ◽  
Jaclyn R O’Connor ◽  
Ayako Shimada ◽  
Scott W Keith ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Risk Score ◽  
Tenofovir Disoproxil Fumarate ◽  
Disease Risk ◽  
Rank Test ◽  
Atherosclerotic Cardiovascular Disease ◽  
Mineral Density ◽  
Ascvd Risk ◽  
Tenofovir Alafenamide

Abstract Background Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF)-containing antiretroviral therapy (ART) can improve renal function and bone mineral density in people with human immunodeficiency virus (PWH). The switch can also negatively influence cholesterol, but changes in body mass index (BMI) and atherosclerotic cardiovascular disease (ASCVD) risk are unknown. Methods This retrospective observational study evaluated BMI and ASCVD risk score changes in virologically suppressed PWH who switched from TDF to TAF without switching other ART regimen components. Adults on TDF for ≥1 year with 2 consecutive HIV ribonucleic acid values <200 copies/mL before a TAF switch were included. Body weight, BMI, cholesterol, and ASCVD risk score were collected for the year before and after the switch. Pre- and postswitch values were compared with the Wilcoxon signed-rank test. Changes in BMI and ASCVD scores were modeled using generalized estimating equations regression. Results One hundred ten patients were included. In unadjusted analyses, there were significant increases in weight, BMI, total cholesterol, LDL, HDL, and ASCVD risk score in the year after switching from TDF to TAF (each P ≤ .01). In regression models, switching from TDF to TAF was associated with a 0.45 kg/m2 increase in BMI (95% confidence interval [CI], 0.14–0.76) and a 13% increase in ASCVD risk score (95% CI, 4%–23%). Conclusions We observed significant BMI and ASCVD score increases in PWH 1 year after switching from TDF to TAF. The mechanism of changes is unclear and requires additional study.

scholarly journals 979. BMI and ASCVD Risk Score Changes in Virologically Suppressed Patients with HIV Switching from TDF to TAF Containing ART

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S37-S38 ◽  
Author(s):  
Jason J Schafer ◽  
Kaitlin Sassa ◽  
Jaclyn O’Connor ◽  
Ayako Shimada ◽  
Scott Keith ◽  
...  
Keyword(s):  
Risk Score ◽  
Repeated Measures ◽  
Risk Scores ◽  
Rank Test ◽  
Atherosclerotic Cardiovascular Disease ◽  
Mineral Density ◽  
Hiv Diagnosis ◽  
Viral Loads ◽  
Signed Rank Test ◽  
Ascvd Risk

Abstract Background Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) containing antiretroviral therapy (ART) can preserve or improve renal function as well as bone mineral density in patients living with HIV infection (PLWH). The switch can also negatively influence cholesterol, but potential changes in body mass index (BMI) and atherosclerotic cardiovascular disease (ASCVD) risk are unknown. Methods This retrospective observational study evaluated BMI and ASCVD risk score changes in virologically suppressed PLWH who switched from TDF to TAF without switching any other ART regimen components. Adult patients on TDF for ≥1 year with two consecutive HIV viral loads <200 copies/mL in the year prior to a TAF switch were included. Bodyweight, BMI, cholesterol, ASCVD risk score, and other variables were collected for the year prior to and following the switch. The unadjusted distributions of pre- and post-switch values were compared with the Wilcoxon signed-rank test. Repeated-measures generalized estimating equations were constructed to evaluate changes in BMI and ASCVD risk scores associated with TDF to TAF switches. These were adjusted for predictors retained in the model if their P-values were <0.05. ASCVD risk scores were skewed right, so those data were log-transformed prior to modeling. Results A total of 110 patients met the criteria and were included for analysis (Table 1). In unadjusted analyses, there were significant increases in weight, BMI, total cholesterol, LDL, HDL, and ASCVD score in the year after switching from TDF to TAF (each P ≤ 0.01, Table 2). Only gender was retained in the adjusted BMI model, which suggested switching from TDF to TAF lead to an increase of 0.45 kg/m2 in the expected mean for BMI (95% CI: 0.14, 0.76). Age, gender, race, concomitant medications that can cause weight gain, and time since HIV diagnosis were retained as covariates in the adjusted ASCVD model. This model suggested that switching from TDF to TAF was associated with a 13% increase in the expected mean for ASCVD risk score (95% CI: 4%, 23%). Conclusion We observed significant increases in BMI and ASCVD risk in PLWH 1 year following a switch from TDF to TAF without changes in other ART regimen components. The mechanism of these metabolic changes is unclear and requires further study. Disclosures All Authors: No reported Disclosures.

Weight and body mass index increase after switch from tenofovir disoproxil fumarate to tenofovir alafenamide fumarate-containing treatment in an antiretroviral therapy-experienced group

2021 ◽  
pp. 095646242098369
Author(s):  
Michał Łomiak ◽  
Jan Stępnicki ◽  
Tomasz Mikuła ◽  
Alicja Wiercińska-Drapało
Keyword(s):  
Body Mass Index ◽  
Body Weight ◽  
Weight Gain ◽  
Antiretroviral Therapy ◽  
Body Mass ◽  
Tenofovir Disoproxil Fumarate ◽  
Weight Changes ◽  
Mineral Density ◽  
Significant Weight Gain ◽  
Tenofovir Alafenamide

Tenofovir alafenamide fumarate (TAF) is an alternative to tenofovir disoproxil fumarate (TDF). Currently, TAF is increasingly being used because of its non-inferior antiviral properties, lower risk of nephrotoxicity, and lower decrease in bone mineral density than TDF. There is growing evidence of unfavorable effects of TAF on weight and body mass index (BMI) in antiretroviral therapy (ART)-experienced patients treated with TAF-based ART. The aim of this study was to evaluate whether switching from TDF-containing to TAF-containing ART is associated with an increase in BMI and body weight in ART-experienced patients. Two study groups were established: 32 patients who switched from TDF to TAF only and 68 patients who switched from TDF to TAF along with changes to other components of the ART regimen. Significant weight gain and BMI increase was observed during the first year after initiation of TAF-containing ART regimens in both groups (mean change +1.91 kg and +0.61 kg/m2 in the first group and +1.50 kg and +0.49 kg/m2 in the second group). During the second year of TAF-based treatment, a sustained trend of body weight and BMI increase was noted only in the second group (mean change +1.46 kg, + 0.46 kg/m2). Analysis of body weight changes in certain subpopulations from the second group (selected based on patients’ baseline characteristics) revealed a significant weight gain within two years after the switch in patients over 50 years old and in those whose ART had lasted longer than 10 years. These findings suggest that a possible impact of TAF on weight gain should be taken into account when selecting ART components, especially in older patients or those with a long history of antiretroviral treatment.

scholarly journals Atherosclerotic Cardiovascular Disease Risk Profile of Tenofovir Alafenamide Versus Tenofovir Disoproxil Fumarate

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Gregory D Huhn ◽  
David J Shamblaw ◽  
Jean-Guy Baril ◽  
Priscilla Y Hsue ◽  
Brittany L Mills ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Total Cholesterol ◽  
Statin Therapy ◽  
Tenofovir Disoproxil Fumarate ◽  
Density Lipoprotein ◽  
Hiv Care ◽  
Atherosclerotic Cardiovascular Disease ◽  
Ascvd Risk ◽  
Tenofovir Alafenamide ◽  
The Impact

Abstract Background In human immunodeficiency virus (HIV) treatment, tenofovir alafenamide (TAF) is associated with greater increases in all fasting cholesterol subgroups compared with tenofovir disoproxil fumarate (TDF). Because lipid abnormalities may contribute to cardiovascular morbidity and mortality, cardiovascular risk assessment is integral to routine HIV care. This post hoc study evaluates the impact of lipid changes on predicted atherosclerotic cardiovascular disease (ASCVD) risk and statin eligibility in treatment-naive adults living with HIV treated with TAF or TDF. Methods Participants (N = 1744) were randomized (1:1) to initiate TAF or TDF, each coformulated with elvitegravir/cobicistat/emtricitabine (studies GS-US-292-0104 and GS-US-292-0111). Eligibility for statin therapy and estimated 10-year ASCVD risk among adults aged 40–79 years treated with TAF or TDF for 96 weeks (W96) were analyzed based on American College of Cardiology/American Heart Association Pooled Cohort Equations. Categorical shifts in 10-year ASCVD risk from &lt;7.5% to ≥7.5% by W96 on TAF versus TDF were calculated. Results Participants initiating TAF versus TDF in the overall study population showed small but significant increases in median fasting lipid parameters at W96, including total cholesterol (191 vs 177 mg/dL; P &lt; .001), low-density lipoprotein ([LDL] 119 vs 112 mg/dL; P &lt; .001), and high-density lipoprotein ([HDL] 51 vs 48 mg/dL; P &lt; .001), respectively. At baseline, 18% and 23% on TAF versus TDF had a 10-year ASCVD risk score ≥7.5%, with mean risk scores low overall for TAF versus TDF at baseline (4.9% vs 5.4%; P = .35) and W96 (6.1% vs 6.2%; P = .04). Increases in ASCVD risk from baseline to W96 were driven by both increasing age and changes in total cholesterol (TC) and HDL cholesterol. At W96, TC/HDL ratios (median) were 3.7 for both groups (P = .69). There was no difference between shifts in categorical risk for TAF versus TDF (9% vs 5%; P = .19). Eligibility for high-intensity statin therapy were similar for TAF versus TDF groups (19% vs 21%; P = .47). Conclusions Lipid changes with TAF as part of coformulated regimens do not substantively affect CVD risk profiles compared with TDF.

scholarly journals Body Mass Index, Multi-Morbidity, and COVID-19 Risk Factors as Predictors of Severe COVID-19 Outcomes

2021 ◽  
Vol 12 ◽  
pp. 215013272110185
Author(s):  
Sanjeev Nanda ◽  
Audry S. Chacin Suarez ◽  
Loren Toussaint ◽  
Ann Vincent ◽  
Karen M. Fischer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Body Mass Index ◽  
Hospital Admission ◽  
Body Mass ◽  
Risk Score ◽  
The Body ◽  
Risk Scores ◽  
Nasopharyngeal Swab ◽  
Morbidity Score ◽  
The Impact

Purpose The purpose of the present study was to investigate body mass index, multi-morbidity, and COVID-19 Risk Score as predictors of severe COVID-19 outcomes. Patients Patients from this study are from a well-characterized patient cohort collected at Mayo Clinic between January 1, 2020 and May 23, 2020; with confirmed COVID-19 diagnosis defined as a positive result on reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assays from nasopharyngeal swab specimens. Measures Demographic and clinical data were extracted from the electronic medical record. The data included: date of birth, gender, ethnicity, race, marital status, medications (active COVID-19 agents), weight and height (from which the Body Mass Index (BMI) was calculated, history of smoking, and comorbid conditions to calculate the Charlson Comorbidity Index (CCI) and the U.S Department of Health and Human Services (DHHS) multi-morbidity score. An additional COVID-19 Risk Score was also included. Outcomes included hospital admission, ICU admission, and death. Results Cox proportional hazards models were used to determine the impact on mortality or hospital admission. Age, sex, and race (white/Latino, white/non-Latino, other, did not disclose) were adjusted for in the model. Patients with higher COVID-19 Risk Scores had a significantly higher likelihood of being at least admitted to the hospital (HR = 1.80; 95% CI = 1.30, 2.50; P < .001), or experiencing death or inpatient admission (includes ICU admissions) (HR = 1.20; 95% CI = 1.02, 1.42; P = .028). Age was the only statistically significant demographic predictor, but obesity was not a significant predictor of any of the outcomes. Conclusion Age and COVID-19 Risk Scores were significant predictors of severe COVID-19 outcomes. Further work should examine the properties of the COVID-19 Risk Factors Scale.

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