2248. Changes in lipid profiles for patients to tenofovir alafenamide (TAF)-containing regimens: perspectives from a military HIV-positive cohort.
Session: Poster Abstract Session: HIV: Metabolic, Cardiovascular, and Renal Complications
Saturday, October 6, 2018
Room: S Poster Hall
Posters
  • Ewers_TAF-Lipid_IDWeek_v2_EE_final.pdf (504.8 kB)
  • Background:

    Tenofovir alafenamide (TAF) was approved in 2015 for use in HIV-1. TAF decreases risk of renal and bone toxicity compared with tenofovir disproxil fumarate (TDF). Early clinical trials reported median increases in low-density lipoprotein (LDL) of 20-29 mg/dL and 9-13 mg/dL for total cholesterol (TC) following switch therapy from TDF-containing regimens at 48 weeks, raising concern for increased cardiovascular (CVD) risk over time. We assessed real-world changes in serum lipid concentrations following transition to TAF-containing regimens.

    Methods:

    Eligible subjects in the US Military Natural History Study, a longitudinal cohort of HIV-infected military beneficiaries, had been switched from TDF to TAF-based regimens, and had pre- and post-switch lipid profiles available. Antiretroviral therapy history, serum lipids, CD4 count and viral load were collected from the study database. Wilcoxon rank sum test was used to compare lipid profile changes.

    Results:

    As of Jan 1, 2018, 408 subjects on TDF switched to TAF; 238 had pre and post lipid profiles. Subjects were primarily male (95%), 45.4% African American, 70% were ≥ 40 years old at TAF start; 8% had CVD and 10% had diabetes. Changes in lipid profiles & CD4 count are presented in Table 1. No difference was seen when categorized by gender, race, or age. Lipid changes were not seen in subjects switched from an efavirenz (EFV) regimen. Increases in TC, HDL, and LDL were observed in those switched from rilpivirine (RPV) (p=0.002, p=0.0404, and p=0.0296) or elvitegravir (EVG) (p<0.0001, p=0.0003, p=0.0040) regimens.

    Conclusion:

    We found significant changes in serum lipids, albeit lower than median changes observed in licensing trials. Changes were not observed in those switching from EFV, contrasting with those switching from RPV or EVG.

    Table 1: Serum lipid profiles. *Concentrations in mg/dL. Values are median [Q1-Q3].

    On TDF

    After TAF-switch (>6 weeks)

    % Change

    P-value

    TC*

    174.0 [154.0 - 197.0]

    184.0 [161.0 - 212.0]

    6.6 [-5.4 - 18.6]

    <0.0001

    HDL

    47.0 [39.0 - 57.0]

    48.0 [41.0 - 57.0]

    2.8 [-7.7 - 17.3]

    0.007

    LDL

    107.0 [86.0 - 124.0]

    112.5 [91.0 - 135.0]

    6.5 [-10.3 - 22.0]

    0.0007

    TC:HDL

    3.7 [2.9 - 4.4]

    3.7 [3.0 - 4.5]

    3.6 [-9.9 - 17.9]

    0.03

    CD4 (cells/uL)

    676.0 [533.0 - 880.0]

    704.0 [562.0 - 917.0]

    6.6 [-8.0 – 20.1]

    <0.0001

    Evan Ewers, MD1, Seunghyun Won, PhD2,3, Jason Okulicz, MD4, Tomas Ferguson, MD, FIDSA5, Robert Deiss, MD2,3,6, Ryan Maves, MD, FCCP, FIDSA6, Karl Kronmann, MD, MPH7, Tahaniyat Lalani, MBBS, MHS2,3,7, Brian Agan, MD2,3, Timothy J. Whitman, DO1 and Anuradha Ganesan, MD, MPH1,2,3, (1)Walter Reed National Military Medical Center, Bethesda, MD, (2)Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, (3)Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, (4)Infectious Disease, San Antonio Military Medical Center, Fort Sam Houston, TX, (5)Tripler Army Medical Center, Tripler AMC, HI, (6)Naval Medical Center San Diego, San Diego, CA, (7)Naval Medical Center Portsmouth, Portsmouth, VA

    Disclosures:

    E. Ewers, None

    S. Won, None

    J. Okulicz, None

    T. Ferguson, None

    R. Deiss, None

    R. Maves, None

    K. Kronmann, None

    T. Lalani, None

    B. Agan, None

    T. J. Whitman, None

    A. Ganesan, None

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