Background Tenofovir alafenamide (TAF) has replaced tenofovir disoproxil fumarate (TDF) in many clinical settings. However, concerns remain about potential metabolic complications of TAF. We aimed to evaluate changes in weight, laboratory markers, and metabolic-related clinical events after replacing TDF with TAF. Methods Multicenter prospective cohort study in the Spanish CoRIS cohort. We included virologically suppressed adults with HIV receiving TDF for more than 12 months who either switched to TAF or maintained TDF, with no changes in the core agent. Participants were matched by propensity score. We fitted generalized equation models to assess changes in weight, blood lipids, and hepatic steatosis index, and to compare the incidence of diabetes, hypertension, and lipid-lowering drug use after 144 weeks. Results 1,446 participants were matched in each group. Median age was 38 years, 85% were male, mean weight at baseline was 73 kilograms. Participants who switched to TAF had a mean weight increase of +0.5 kg at 144 weeks over those who maintained TDF, with no difference in the occurrence of overweight or obesity. Individuals who switched to TAF had a significant increase in total cholesterol (+7.9 mg/dL) and triglycerides (+11.2 mg/dL), with no differences in the total cholesterol-HDL ratio. However, no increased incidence of diabetes, hypertension, or lipid-lowering drug use was observed after the follow-up period. Conclusions Switching from TDF to TAF is associated with modest weight gain and increases in total cholesterol and triglycerides, without an impact on the incidence of obesity or metabolic-related clinical events, in this Spanish cohort with a majority white male population.

中文翻译：

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成人 HIV 感染者从富马酸替诺福韦二吡呋酯转换为替诺福韦艾拉酚胺后的代谢相关结果：一项多中心前瞻性队列研究。

背景 替诺福韦艾拉酚胺 (TAF) 在许多临床环境中已取代富马酸替诺福韦二吡呋酯 (TDF)。然而，人们仍然担心 TAF 的潜在代谢并发症。我们旨在评估用 TAF 替代 TDF 后体重、实验室标志物和代谢相关临床事件的变化。方法 在西班牙 CoRIS 队列中进行多中心前瞻性队列研究。我们纳入了接受 TDF 超过 12 个月的病毒学抑制的 HIV 成人，他们要么改用 TAF 要么维持 TDF，核心药物没有变化。参与者通过倾向得分进行匹配。我们拟合广义方程模型来评估体重、血脂和肝脂肪变性指数的变化，并比较 144 周后糖尿病、高血压和降脂药物使用的发生率。结果 1, 每组匹配 446 名参与者。中位年龄为 38 岁，85% 为男性，基线平均体重为 73 公斤。与维持 TDF 的参与者相比，改用 TAF 的参与者在 144 周时的平均体重增加了 +0.5 kg，超重或肥胖的发生率没有差异。改用 TAF 的个体总胆固醇（+7.9 mg/dL）和甘油三酯（+11.2 mg/dL）显着增加，总胆固醇-HDL 比率没有差异。然而，随访期后未观察到糖尿病、高血压或降脂药物使用的发生率增加。结论 从 TDF 转换为 TAF 与适度的体重增加以及总胆固醇和甘油三酯的增加有关，但对肥胖或代谢相关临床事件的发生率没有影响，