Martini Salvatore, Maggi Paolo, Gervasoni Cristina, Onorato Lorenzo, Ferrara Sergio, Alessio Loredana, Bellacosa Chiara, Esposito Vincenzo, Di Filippo Giovanni, Masiello Addolorata, Maddaloni Adelaide, Madonia Simona, D'Alessio Giovanna, Rizzo Viviana, Coppola Nicola
Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania, Luigi Vanvitelli, 80131 Naples, Italy.
AORN Sant'Anna e San Sebastiano of Caserta, 81100 Caserta, Italy.
Biomedicines. 2022 Dec 7;10(12):3164. doi: 10.3390/biomedicines10123164.
Background: The introduction of tenofovir alafenamide (TAF) in antiretroviral therapy has deeply modified the choice of the backbone for different treatment regimens, allowing the prevention of the bone and renal toxicity that was related to the previous formulation of tenofovir disoproxil fumarate (TDF). At the same time, literature data show an onset of dyslipidemia after a switch from TDF to TAF. To better understand the possible role of TAF in dyslipidemia, antiretroviral-naïve HIV-infected patients were evaluated, comparing those treated with TAF/emtricitabine with those with abacavir/lamivudine. Methods: We enrolled 270 antiretroviral-naïve HIV-infected patients in an observational, retrospective, longitudinal, multicenter study; they started treatment from 2017 to 2019 and were followed up for at least 72 weeks. We divided patients into two groups, one treated with a TAF-based backbone in their antiretroviral regimens (TAF group) and one without TAF (NO TAF group), to evaluate possible differences in the dynamics of lipid profiles from baseline(T0) to week 24 (T24), 48 (T48) and 72 (T72). Results: No significant differences were observed at baseline between the 2 groups. In the TAF group we observed a significant development of hypercholesterolemia throughout the follow-up (p < 0.0001), not evident in the NO TAF group, that instead showed a significant increase in high-density lipoprotein (HDL). There were no significant differences between the two groups regarding triglycerides, low-density lipoprotein (LDL) and cardiovascular risk index (CRI). A cholesterol-lowering treatment with statin, finally, was prescribed in 6 patients in both groups during the study. At binary logistic regression analysis, no factor was independently associated with hypercholesterolemia, except for higher age at T0. Conclusions: This real-life study shows that in HIV-naïve patients, TAF was associated with hypercholesterolemia throughout the follow-up. The clinical significance of this hypercholesterolemia will have to be clarified in further studies.
替诺福韦艾拉酚胺（TAF）引入抗逆转录病毒治疗后，极大地改变了不同治疗方案的骨干药物选择，能够预防与之前的富马酸替诺福韦二吡呋酯（TDF）制剂相关的骨骼和肾脏毒性。同时，文献数据显示从TDF转换为TAF后会出现血脂异常。为了更好地理解TAF在血脂异常中可能扮演的角色，我们对未接受过抗逆转录病毒治疗的HIV感染患者进行了评估，比较了接受TAF/恩曲他滨治疗的患者和接受阿巴卡韦/拉米夫定治疗的患者。方法：我们纳入了270例未接受过抗逆转录病毒治疗的HIV感染患者，进行一项观察性、回顾性、纵向、多中心研究；他们于2017年至2019年开始治疗，并随访至少72周。我们将患者分为两组，一组在其抗逆转录病毒治疗方案中使用基于TAF的骨干药物（TAF组），另一组不使用TAF（非TAF组），以评估从基线（T0）到第24周（T24）、48周（T48）和72周（T72）血脂谱动态变化的可能差异。结果：两组在基线时未观察到显著差异。在TAF组中，我们观察到在整个随访期间高胆固醇血症有显著发展（p < 0.0001），在非TAF组中不明显，而非TAF组显示高密度脂蛋白（HDL）显著增加。两组在甘油三酯、低密度脂蛋白（LDL）和心血管风险指数（CRI）方面没有显著差异。最后，在研究期间两组均有6例患者接受了他汀类药物的降胆固醇治疗。在二元逻辑回归分析中，除了T0时年龄较大外，没有因素与高胆固醇血症独立相关。结论：这项真实世界研究表明，在未感染HIV的患者中，TAF在整个随访期间与高胆固醇血症相关。这种高胆固醇血症的临床意义有待进一步研究阐明。
