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Planning HIV therapy to prevent future comorbidities: patient years for tenofovir alafenamide
Author(s) -
Shafran SD,
Di Perri G,
Esser S,
Lelièvre JD,
Parczewski M
Publication year - 2019
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/hiv.12755
Subject(s) - tenofovir alafenamide , medicine , atazanavir , ritonavir , cobicistat , population , lopinavir , tolerability , abacavir , viral load , immunology , adverse effect , human immunodeficiency virus (hiv) , antiretroviral therapy , environmental health
Since the introduction of suppressive antiretroviral therapy ( ART ), HIV has become a chronic disease, with infected people in high‐income countries approaching similar life expectancy to the general population. As this population ages, an increasing number of people with HIV are living with age‐, treatment‐, and disease‐related comorbidities. Lifestyle factors such as smoking, alcohol abuse, and substance misuse have a role in age‐related comorbidity. Some degree of immune dysfunction is suggested by the presence of markers of immune activation/inflammation despite effective suppression of HIV replication. Cumulative exposure to some antiretroviral drugs contributes to HIV ‐associated comorbidities, with risk increasing with age. Specifically, tenofovir disoproxil fumarate ( TDF ), ritonavir‐boosted atazanavir, and ritonavir‐boosted lopinavir are associated with renal impairment, and TDF is known to cause loss of bone mineral density. Tenofovir alafenamide ( TAF ) was developed to improve on the safety profile of TDF , while maintaining its efficacy. TAF has better stability in plasma, and higher intracellular accumulation of tenofovir diphosphate in target cells, which has resulted in improved antiviral activity at lower doses with improved renal and bone safety. TAF has been studied extensively in randomized clinical trials and real‐world studies. TAF ‐based regimens are recommended over TDF ‐containing regimens for the improved safety profile.