Tenofovir Alafenamide and Weight Gain in HIV-1 Patients

Evidence of TAF-Associated Weight Gain

Greater weight gain has been consistently observed with regimens containing TAF compared to those containing TDF in multiple studies 1, 3
The majority of patients receiving antiretroviral therapy (ART) experience weight changes of less than 5% of body weight, but a minority gain more than 10% of their body weight 1
Weight gain typically occurs within the first year following initiation or switch to TAF-containing regimens 3

Women and Black individuals are at higher risk for weight gain with TAF-containing regimens 3
Weight gain is not solely a "return to health" phenomenon but appears to be medication-related 3

TDF and efavirenz are associated with less weight gain as initial therapy and with weight loss when switching to these drugs 3
The reversibility of TAF-associated weight gain is limited, with return to pre-therapy weight being rarely observed 3
In the Swiss HIV Cohort Study, weight loss was seen when patients switched from TAF back to TDF 3

Documentation of weight and BMI every 6 months is recommended for individuals initiating or switching to a TAF-based regimen (evidence rating: AIIa) 4
Despite weight gain concerns, changing regimens solely because of weight gain is not currently recommended due to known toxicities of alternative agents like TDF (evidence rating: BIa) 4
Lifestyle changes including diet and exercise should be emphasized for patients on TAF-containing regimens (evidence rating: AIII) 5
Glucagon-like peptide-1 receptor agonists may be effective for weight loss in people with HIV, similar to the general population 6

Patients on TAF-based regimens should have their weight monitored regularly, particularly during the first year of treatment 3