Editor’s Note:
AIDS remains a significant global health concern, but recent advancements in medical technology have shifted the treatment of HIV-infected individuals toward a chronic disease management approach. Ensuring treatment safety and adherence is a critical challenge within this context. Currently, two single-tablet regimens, Biktarvy (B/F/TAF) and Descovy (E/C/F/TAF), are widely used globally, including in China, for managing HIV infections. These regimens not only effectively suppress the virus but also offer good safety and adherence rates. In recent years, concerns have arisen about complications related to HIV infection, particularly the increased risk of cardiovascular diseases (CVD) associated with long-term antiretroviral drug use. This risk significantly affects the life expectancy and long-term health of HIV-infected individuals. From October 18 to 20, 2023, the 19th European AIDS Conference (EACS 2023) was held in Warsaw, Poland. During the conference, a clinical study led by Professor Zhu Biao from the First Affiliated Hospital of Zhejiang University School of Medicine was featured as a poster presentation (Abstract No. 551). This study suggests that compared to E/C/F/TAF, B/F/TAF has a milder impact on lipid metabolism and is associated with a reduced risk of CVD.
Research Poster
This prospective study aimed to compare the effects of E/C/F/TAF and B/F/TAF on lipid metabolism in real-world settings among HIV-infected individuals.
The study included HIV-infected individuals aged 18 and above, who had been on the E/C/F/TAF regimen for at least 6 months, with HIV RNA levels consistently below 50 copies/mL. Participants were divided into two groups based on their preference: the E/C/F/TAF maintenance group (n=25) and the B/F/TAF switch group (n=19), with follow-up visits every 12 weeks. Clinical data and blood samples were collected at baseline (Week 0), 12 weeks, and 24 weeks, and lipidomic analysis was conducted using liquid chromatography-mass spectrometry (LC-MS).
Results revealed that at baseline, both groups had similar clinical characteristics. However, at Week 24, the group that switched to B/F/TAF showed a significant reduction in triglyceride (TG, P=0.001) and very low-density lipoprotein cholesterol (VLDL-C, P=0.037) levels compared to the E/C/F/TAF group (see Figure 1). Additionally, the Framingham Comprehensive Cardiovascular Risk Score (FRS) decreased in the B/F/TAF group.
Figure 1. Changes in TG, VLDL-C, and FRS Scores in the B/F/TAF and E/C/F/TAF Groups at the 24-Week Follow-up
Furthermore, the analysis indicated that E/C/F/TAF increased the levels of diacylglycerols (DG), triacylglycerols (TAGs), and lysophosphatidylcholines (LPCs), which were positively correlated with FRS but unrelated to age, gender, body mass index, TG, and high-density lipoprotein cholesterol. Conversely, switching to B/F/TAF treatment led to an elevation of sphingolipids and glycerophospholipids, which were negatively correlated with FRS.
Figure 2. Impact of E/C/F/TAF and B/F/TAF on Lipidomic Characteristics
A: Lipid abundance in plasma; B: Heatmap of significantly changed lipidomic species in participants
Figure 3. Multivariate Linear Regression Reveals the Association of Lipid Species with Future Cardiovascular Disease Risk in People Living with HIV
In summary, this real-world study suggests that E/C/F/TAF promotes lipid accumulation in HIV-infected individuals, which is closely associated with the risk of CVD. In contrast, B/F/TAF has a milder impact on the lipid profile of HIV-infected individuals and may reduce the risk of CVD.
Original Article Link: Zhikai Wan, Xueling Zhu, Xiang Liu, et al. Distinct lipidomic signatures in people living with HIV treated with EVG/c/FTC/TAF or BIC/FTC/TAF: a real-world prospective cohort study. EACS 2023 Abstract 551.
Professor Zhu Biao
First Affiliated Hospital of Zhejiang University School of Medicine
