Vemlidy makes weight gain in people with HIV

March 23, 2021

1 min read

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Surial reports on Gilead Sciences travel grants outside of the work submitted. In the study you will find all relevant financial information from all other authors.

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Over time, people with HIV who were given Vemlidy instead of Viread as part of their antiretroviral therapy experienced weight gain and other negative metabolic changes, researchers reported in Annals of Internal Medicine.

Previous research has shown that people with HIV (PLWH) who switched from Viread (tenofovir disoproxil fumarate, Gilead Sciences; TDF) to Vemlidy (tenofovir alafenamide fumarate, Gilead Sciences; TAF) maintained virologic suppression with significant improvements in kidney and bone safety. TAF is “first in all major HIV guidelines,” the researchers found.

Reference: Surial B et al. Ann Intern Med. 2021; doi: 10.7326 / M20-4853.

Despite these benefits, PLWH can experience weight gain associated with antiretroviral therapy (ART).

Bernard Surial, MD, From the Department of Infectious Diseases of the University Hospital Bern and the University of Bern in Switzerland, colleagues carried out a cohort study to assess changes in weight, the development of overweight or obesity, and changes in lipid levels after switching from TDF to TAF. From January 1, 2016 to July 31, 2019, they followed 4,375 PLWH in Switzerland. The mean age of the patients at the start of the study was 50 years; 25.9% were women; and 51.7% had a normal BMI. All patients had received TDF-containing ART for at least 6 months – 79.6% eventually switched their treatment to TAF, while the others received TDF by the end of the study.

The researchers wrote that switching from TDF to TAF after 18 months resulted in an adjusted mean weight gain of 1.7 kg (95% CI, 1.5-2) compared to 0.7 kg (95% CI, 0.4 -1) was associated with an intermediate group difference of 1.1 kg (95% CI, 0.7-1.4). For PLWH with a normal BMI, 13.8% of those who switched their therapy to TAF also became overweight / obese, compared with 8.4% of those who continued to receive TDF (difference = 5.4 percentage points; 95% CI, 2, 1-8.8). Switching to TAF also led to an increase in the adjusted mean total cholesterol level (0.25 mmol / l), high-density lipoprotein cholesterol (0.05 mmol / l), LDL cholesterol (0.12 mmol / l) and the after 18 Triglyceride level (0.18 mmol / L) months.

Surial said in a press release that “Cardiovascular complications are a leading cause of illness and death in people living with HIV. Accordingly, the metabolic changes found are of great importance. “

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Rajesh Gandhi, MD

Combinations of HIV drugs control the virus and prevent it from weakening the immune system, preventing life-threatening complications. Because HIV drugs control but not cure HIV, people with HIV must take drugs for life. For this reason, increasing care is taken to ensure that the drugs do not cause any side effects.

Tenofovir is one of the main medicines used to treat people with HIV. There are two types of tenofovir that are commonly used: TDF, the older form, and TAF, the newer. The reason many doctors have recommended switching to TAF is because it has fewer negative effects on kidneys and bones than TDF.

Studies other than those by Surial and colleagues have found greater weight gains associated with TAF. These and other studies lead to the question of whether turning off TAF – and replacing another drug – results in weight loss or stabilization. There are ongoing studies to answer this question. Currently, clinicians with patients should decide on a case-by-case basis whether to use TAF or TDF, depending on their health status, concerns and goals. What shouldn’t be overlooked is that the benefits of anti-HIV drugs – including TAF and TDF – far outweigh their risks, as controlling HIV prevents serious and even life-threatening complications. Knowing more about the side effects of these drugs, including weight gain, can help us develop treatments that are less likely to cause side effects and are more likely to keep people with HIV healthy for the long lives ahead.

Rajesh Gandhi, MD

Professor of Medicine, Massachusetts General Hospital, Chairman of the HIV Medicine Association

Disclosure: Gandhi does not report any relevant financial information.

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Steven K. Grinspoon, MD

This study by Surial and colleagues complements the growing literature on the effects of TAF on weight and metabolic parameters in people with HIV. It remains unclear whether these different effects are due to the direct effects of TAF or to the elimination of the effects of TDF.

The study’s strengths include real-world nature, large cohort sizes, and sensitivity analyzes stratified by basis weight and other regimens used. One of the study’s weaknesses is the fact that the switch was not randomized. In this respect, a mix-up could not be completely ruled out. Nonetheless, the results are consistent with the differences in weight gain seen with TAF versus TDF in the randomized controlled trial, the ADVANCE trial.

Clinicians considering switching their patients to TAF from TDF should take into account that this change may be associated with slight weight gain and increases in lipids, especially in people of African American descent and women. These effects should be weighed against the beneficial effects of TAF on bone and kidney disease versus those experienced in patients taking TDF.

Steven K. Grinspoon, MD

Professor of Medicine at Harvard Medical School
Head of the Metabolism Unit and Endowed Chair of Neuroendocrinology and Metabolism at Massachusetts General Hospital
Director of the Nutrition Obesity Research Center at Harvard

Disclosure: Grinspoon reports that its facility has received research support from Gilead and ViiV Healthcare. He also reports receiving consulting fees from Theratechnologies.

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