Mixed
Tenofovir alafenamide (TAF) is associated with greater weight gain compared to Tenofovir disoproxil fumarate (TDF), which appears to have a weight-mitigating effect.
If your HIV medication contains TAF (tenofovir alafenamide), you may gain more weight than if you were on TDF (tenofovir disoproxil fumarate). TDF seems to help mitigate weight gain. If you are concerned about weight, ask your doctor if switching your tenofovir prodrug from TAF to TDF is an option for you, keeping in mind that TDF may have other side effects like kidney or bone issues.
In the aggregate, it appears that TDF and abacavir have a weight-mitigating effect over TAF. The jury is still out on TAF’s individual effect on weight gain, or whether it is weight-neutral, but registration data with new agents from completely different classes, where TAF is commonly within the comparator regimen, will shed light on this in 2023.
Why this rating
Supported by registration data, prospective studies, and switch studies, though mechanistic clarity is lower than for INSTIs.
Source
Weight Gain After HIV Therapy Initiation: Pathophysiology and Implications
Nomathemba Chandiwana et al. · The Journal of Clinical Endocrinology & Metabolism · 2023
DOI 10.1210/clinem/dgad411
More from this paper
- Initiation of modern antiretroviral therapy (ART), specifically integrase strand transfer inhibitors (INSTIs) like dolutegravir and bictegravir combined with tenofovir alafenamide (TAF), causes significant, sustained weight gain in people living with HIV, disproportionately affecting women and Black patients.Good
- Integrase strand transfer inhibitors (INSTIs), particularly dolutegravir and bictegravir, are the primary drivers of weight gain in modern ART regimens, with effects observed as early as 4 weeks post-initiation.Good
Related findings · Mixed
- Bariatric surgery (VSG and RYGB) is the most effective and sustainable treatment for obesity, producing marked and sustained weight loss that non-surgical interventions cannot match.Strong
- Severely protein-deficient diets (2–3% energy) induce lean body mass loss and metabolic imbalance, whereas adequate protein intake (0.66 g/kg/d minimum) is a prerequisite for maintaining muscle, bone, and physiological function.Strong
- For patients with Class III obesity (BMI >39.9 kg/m2), metabolic bariatric surgery (MBS) is significantly more effective than any currently approved medication, with BilioPancreatic Diversion (BPD) showing the highest estimated weight loss.Strong
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