Metabolic effects of switching to Biktarvy (B/F/TAF) in patients with HIV-1 treated with antiretroviral regimens that do not include tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF): The Metabic study

C Busca-Arenzana; D Ortega-González; M Díaz-Almirón; M L Montes; Luz Martin-Carbonero; R Mican; R Montejano; L Ramos-Ruperto; Eulalia Valencia; Ana Delgado-Hierro; Jose I Bernardino

doi:10.1111/hiv.13659

Metabolic effects of switching to Biktarvy (B/F/TAF) in patients with HIV-1 treated with antiretroviral regimens that do not include tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF): The Metabic study

HIV Med. 2024 May 15. doi: 10.1111/hiv.13659. Online ahead of print.

Authors

C Busca-Arenzana^{1

2}, D Ortega-González¹, M Díaz-Almirón³, M L Montes^{1

2}, Luz Martin-Carbonero^{1

2}, R Mican^{1

2}, R Montejano^{1

2}, L Ramos-Ruperto^{1

2}, Eulalia Valencia^{1

2}, Ana Delgado-Hierro¹, Jose I Bernardino^{1

2}

Affiliations

¹ HIV Unit, Hospital Universitario de La Paz-Carlos III, IdiPAZ, Madrid, Spain.
² CIBER de Enfermedades Infecciosas CIBER INFEC, Instituto de Salud Carlos III, Madrid, Spain.
³ Biostatistics Unit, La Paz Research Institute, IdiPAZ, Madrid, Spain.

PMID: 38746980
DOI: 10.1111/hiv.13659

Abstract

Background: Studies on switching to tenofovir alafenamide (TAF)-based regimens raise concerns about a worse metabolic profile in people with HIV, even though most received tenofovir disoproxil fumarate (TDF) in their previous regimen. This study aims to evaluate changes in lipid fractions, glucose, and serum markers for hepatic steatosis (HS) after switching from a TDF- or TAF-sparing regimen to bictegravir/emtricitabine/TAF (B/F/TAF).

Methods: We performed a retrospective cohort study of people with HIV who switched to B/F/TAF from TDF- or TAF-sparing regimens between January 2019 and May 2022 with at least 6 months of follow-up. The primary endpoint was the absolute change in lipid fractions at 6 months. Secondary outcomes were changes in lipid fractions at 12 months and changes in other metabolic parameters (glucose, creatinine, and HS based on the triglyceride-to-glucose [TyG] ratio at 6 and 12 months). Changes were analysed using mixed linear regression models with random intercept and time as a fixed effect.

Results: The study included 259 people with HIV (median age 55 [interquartile range (IQR) 47-60] years; 80% male; 88% Caucasian; CD4+ T-cell count 675 [IQR 450-880] cells/mm³; 84.3% HIV-RNA <50 copies/mL). In total, 63 patients (30%) had hypertension, 93 (44%) dyslipidaemia, 30 (14%) diabetes, and 45% obesity/overweight. Most (60%) switched from integrase inhibitor-based regimens, and 21% switched from a boosted regimen. At 6 months, significant reductions were observed in total cholesterol (-7.64 mg/dL [95% confidence interval (CI) -13.52 to -1.76; p = 0.002]), triglycerides (-23.4 [95% CI -42.07 to -4.65]; p = 0.003), and TyG ratio (-0.14 [95% CI -0.23 to -0.05]; p < 0.001).

Conclusion: In our real-life cohort, the effect of switching TDF-/TAF-sparing regimens to triple therapy with B/F/TAF improved total cholesterol, triglycerides, and serum markers of HS at 6 months and was neutral for the remaining metabolic parameters at 12 months.

Keywords: ART‐experienced; B/F/TAF; antiretroviral therapy; bictegravir; dislipemia; metabolic disorders.