Weight gain on tenofovir alafenamide fumarate‐based therapy compared to tenofovir disoproxil fumarate‐ and abacavir‐based therapy in children and young people living with HIV in Europe

Objective To compare BMI‐for‐age z ‐score (zBMI) changes in treatment‐experienced children and young people living with HIV aged 6 to <25 years on tenofovir alafenamide fumarate (TAF) to those on tenofovir disoproxil fumarate (TDF) and abacavir (ABC). Methods Cohort study of children and young people living with HIV from 12 European countries were grouped by drug exposure: 1 ‐ on TAF with prior TDF use; 2 ‐ on TAF no prior TDF; 3 ‐ on TDF; and 4 ‐ on ABC. Outcomes, adjusted for characteristics at drug start, were (i) incidence of overweight or obesity by 96 weeks, (ii) zBMI change 48 weeks before/after drug start, (iii) association between TAF/TDF/ABC and anchor drug on zBMI change and (iv) factors associated with zBMI change on TAF over 96 weeks. Results Overall, 162, 189, 270 and 144 were in groups 1, 2, 3 and 4, respectively. Median ages at drug start were 16, 13, 14 and 12 years. Obesity incidence by 96 weeks was 16%, 13%, 6% and 12% and higher on TAF than TDF ( p = 0.018) but comparable to ABC ( p = 0.568). Similar trends were seen for overweight/obesity, although differences were not significant. Over 48 weeks, zBMI increased at a higher rate on TAF than TDF ( p = 0.001) but similar to ABC ( p = 0.652). zBMI change was higher after than before drug start in group 1 ( p = 0.059) but similar in other groups. Over 96 weeks zBMI change on TAF/TDF/ABC combined with dolutegravir vs. other anchor drugs was not statistically different ( p = 0.196). zBMI change on TAF varied by age ( p = 0.001), prior TDF ( p = 0.019), viral load ( p = 0.042) and zBMI ( p = 0.004) at TAF start. Conclusion zBMI increased on TAF, faster than TDF, but similar to ABC. Weight gain on TAF was associated with multiple factors including prior TDF use.