HealthDay Reporter
HOMES, March 16, 2021 (HealthDay News) – A commonly prescribed portion of the cocktails of life-saving antiretroviral drugs used to treat HIV may be weight gain, new research warns.
The concern stems from the monitoring of patients receiving antiretroviral therapy (ART). Since the mid-1990s, treatment has relied on a number of drug compounds to eradicate HIV, control viral loads and turn a once deadly disease into an easily susceptible condition. treatment.
But the new research raises questions about one drug that appears in many ART recipes: tenofovir alafenamide, also known as TAF.
There is no question that TAF works. The researchers noted that it is both effective and well tolerated. And TAF has become very popular in recent years because it poses less of a risk to kidney and bone health than another drug, called tenofovir disoproxil fumarate (TDF).
But the new study found that, over 18 months, patients on an antiretroviral tablet containing TAF averaged nearly 4 pounds, compared to about 1.5 pounds among patients on cocktails containing TDF-containing drugs.
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As a result nearly 14% of normal TAF weight users became obese or obese, compared to just over 8% of their TDF peers, the results showed.
“TDF and TAF are common components of these combo drugs and most ART regimens,” said Dr. Michael Horberg, director of the Kaiser Permanente division of HIV / AIDS and STDs. “That’s why this study is so important.”
Horberg, who was not involved in the study but reviewed the findings, pointed out that both drugs are also part of the majority of PrEP regimens. PrEP (pre-exposure prophylaxis)designed to prevent HIV infections from becoming infected in the first place, “hence a greater number of people [are] probably use it for that, “he said.
Horberg said the latest TAF drug is considered “the answer” to the major problem with the older TDF drug, which raised creatinine levels in some patients, a sign of worsening renal activity .
“And, for the most part, that’s true,” Horberg said.
He said the new study is crucial, however, since weight gain and worsening lipid levels are not “just a few extra issues.” Lipids are the fatty substances that can build up up and squeezing arteries.
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Most people don’t want to gain weight because of medication, ”and rising lipids can be linked to cardiovascular disease (heart attacks, strokes), which we want to prevent in humans with HIV too, “Horberg said.
For the study, a team led by Dr. Bernard Surial of Bern University Hospital in Switzerland reviewed weight gain data collected from more than 3,400 Swiss HIV patients between 2016 and 2019.
They had all been taking an antiretroviral cocktail containing the oldest TDF drug for at least six months, before switching to an ART regimen containing the newest TAF drug.
Weight gain among patients who then undergone the accumulation was accumulated against nearly 900 patients who were stitched with TDF during 18 months of detection.
In that time, the researchers found that not only were weight gain benefits much more important among TAF users, but so was an increase in their cholesterol and triglyceride levels, which may be indicates an increased risk of heart problem.
Horberg said the findings come as little surprise.
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“Our patients were noticing this weight gain before we were,” he said. “And we’d say ‘oh, it’s not the meds. You just eat more because you do better.’ Well, we know now that that’s not true. And if they didn’t have kidney problems, we might be trying to correct a problem that didn’t exist “by changing treatments.
So what does this mean for treatment options going forward?
“Really, this has to be done on a case-by-case basis,” Horberg said.
One consideration is money, he noted, since TDF is now a generic and much cheaper drug than TAF.
“We want these medications to be available to everyone, including for PrEP,” Horberg said. “But weightlifting is an important issue, and many patients don’t like how it makes them feel or look,” PrEP recipients added.
If weight loss is a result of the medication, they will stop taking it, Horberg said, so a balance must be struck. If there are renal concerns, it is important to adjust. If not, doctors should discuss the benefits and advantages of any change with their patients, he suggested.
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Dr. Rajesh Gandhi, a member of the American Infectious Diseases Association, and chairman of the HIV Medicine Association, also reviewed the results of the study.
“This weight gain difference is something we pay attention to because we are trying to keep people healthy for decades, not for years,” Gandhi said.
The drugs that changed the treatment of HIV in the mid-1990s effectively controlled the virus, but did not eradicate it. That means once a patient starts taking ART meds, they continue for the rest of their lives, making side effects a cause for concern, he explained.
“Today, there are far fewer side effects than when ART came on the scene,” Gandhi said. “And the weight gain found among those taking the newer form of tenofovir was relatively small. And it didn’t affect everyone. But there was a difference.”
For patients with borderline kidney disease or osteoporosis, the new formula has many benefits, Gandhi said, adding that more concerns about weight concerns are needed.
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In the meantime, decisions about which design to use should be based on a conversation with each patient’s healthcare provider “and decided on a case-by-case basis,” he said.
The study was published online March 16 in the History of internal treatments.
Find out more
Learn more about antiretroviral therapy at the U.S. National Institutes of Health.
SOURCE: Michael Horberg, MD, MAS, director, HIV / AIDS and STDs, Kaiser Permanente and Institute for Care Management, Rockville, Md .; Rajesh Gandhi, MD, chairman and fellow, American Infectious Diseases Association, and chairman, HIV Medicine Association; History of internal treatments, March 16, 2021, online