Background: 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 a 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.