Real-Life Impact on Lipid Profile of a Switch from Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in HIV-Infected Patients

Jennifer Lagoutte-Renosi (1, 2) , Mylène Flammang (3) , Catherine Chirouze (3, 4) , Geneviève Beckwirth (5) , Fabienne Bozon (6) , Anne-Sophie Brunel (3) , Marie-Christine Drobacheff-Thiebaut (3) , Adeline Foltzer (3) , Laurent Hustache-Mathieu (6) , Jakub Kowalczyk (5) , Catherine Michel (5) , Siamak Davani (3) , Patrice Muret (2)

1 Laboratoire de Pharmacologie Clinique et Toxicologie [CHRU Besancon]
2 UBFC - Université Bourgogne Franche-Comté [COMUE]
3 CHRU Besançon - Centre Hospitalier Régional Universitaire de Besançon
4 LCE - Laboratoire Chrono-environnement (UMR 6249)
5 GHRMSA - Groupe hospitalier de la région de Mulhouse Sud-Alsace
6 service de maladies infectieuses CHU J Minjoz Besancon

Tenofovir disoproxil fumarate is a prodrug of tenofovir diphosphate that exposes patients to renal toxicity over the long term. Tenofovir alafenamide, a new prodrug, now makes it possible to reduce toxicity, but at the cost of an alteration in lipid profile. There is currently no recommendation for follow-up of lipid profile when switching from tenofovir disoproxil fumarate to tenofovir alafenamide.

Objective: Our study aimed to evaluate the effects on renal function and lipid profile of a switch from tenofovir disoproxil fumarate to tenofovir alafenamide, and the consequences for patient management.

Methods: Demographic, clinical and biological data was recorded from a retrospective clinical cohort study in real-life, including patients who switched from tenofovir disoproxil fumarate to tenofovir alafenamide. A descriptive analysis of the study population, with comparison of biological parameters using the paired Student t test for paired data was performed.

Results: From January 2016 to January 2019, a total of 103 patients were included. There was no significant difference in renal function before vs after the switch in therapy (p=0.29 for creatinine, p=0.30 for phosphoremia). We observed a change in lipid profile, with a significant increase in total cholesterol (p=0.0006), HDL cholesterol (p=0.0055) and triglycerides (p=0.0242). Four patients received lipid-lowering therapy after switching.

Conclusion: In patients who switch from tenofovir disoproxil fumarate to tenofovir alafenamide, lipid profile is altered, and may require initiation of lipid-lowering therapy. It seems necessary to monitor lipid parameters after this switch, despite the absence of an official recommendation.

Mots clés: HIV; adverse events; dyslipidemia; hypolipidemic agents; tenofovir alafenamide fumarate; tenofovir disoproxil fumarate

Domaines: Médecine humaine et pathologie; Microbiologie et Parasitologie

Jennifer Lagoutte-Renosi, Mylène Flammang, Catherine Chirouze, Geneviève Beckwirth, Fabienne Bozon, et al.. Real-Life Impact on Lipid Profile of a Switch from Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in HIV-Infected Patients. Current HIV Research, 2020, 18, ⟨10.2174/1570162X18666200824101838⟩. ⟨hal-03068359⟩