New HIV pill causes weight gain, study finds

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  • A new HIV treatment has been found to cause weight gain compared to the old version
  • Increased cholesterol and fat levels were found in the blood of patients who made the switch
  • Experts recommend that an individualised approach to HIV medication should be taken 

People who changed their HIV treatment to tenofovir alafenamide (TAF) gained 1.7 kg more than individuals who remained on tenofovir disoproxil fumarate (TDF), who gained only 0.7 kg during an 18 month observation period.

Tenofovir is used as part of standard HIV treatment. TDF was previously widely used and has been linked to renal side effects and bone loss. TAF is the new variant that replaced TDF and has been found to have fewer side effects.

Comparing the two treatments

The study published in the Annals of Internal Medicine enrolled 4 375 participants of the Swiss HIV Cohort Study who had been treated with a TDF-based therapy for a minimum of six months before the start of the study. The main purpose of the research was to determine the change in weight and fat levels induced by switching from TDF to TAF. The research was part of a larger study that examined the effects of the switch.

Leading to disproportionate weight gain

The main finding of the study revealed that people who switched to TAF therapy gained significantly more weight than individuals who remained on TDF over the 18 months they were observed. The results also show that 13.8% of people who had a normal body mass index became overweight or obese with TAF, compared to 8.4% receiving TDF.

The scientists also noted an increase in cholesterol and fat levels in the blood of those who made the switch.

"The result was very consistent. Cardiovascular complications are a leading cause of illness and death in people with HIV. Accordingly, the metabolic changes found are of great significance," says lead author Dr Bernard Surial in a press statement.

What does this mean for patients?

The experts say that the research shows that more attention needs to be given to the problem of weight gain when switching to TAF. They recommend that health practitioners should not automatically switch from TDF to TAF and that individual counselling should be used to develop an optimal patient-specific solution. The advantages of better renal tolerance and avoidance of bone loss must be balanced against the disadvantages of weight gain and increased cholesterol and fat in the blood.

The results of the study also mean that further studies are needed to look at the impact of the switch between the two drugs.

"With its large number of participants, the significant result of our study for patient care helps both in the individual counselling of people with HIV and in the optimisation of the international HIV guidelines. In future, more in-depth studies will be necessary to investigate the exact mechanisms of the metabolic changes and especially their effects (heart attacks, diabetes, etc.). Needless to say, the search also continues for new drugs that can ensure successful HIV therapy without negative effects in the long term," explains Prof Andri Rauch, the head of the study.   

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