BMC Infect Dis. 2026 Apr 25. doi: 10.1186/s12879-026-13377-5. Online ahead of print.
ABSTRACT
BACKGROUND: Tenofovir alafenamide (TAF) is widely used in antiretroviral therapy due to its improved renal and bone safety compared to tenofovir disoproxil fumarate (TDF). However, concerns remain regarding its potential metabolic effects and cardiovascular risk. We aimed to compare lipid parameters and surrogate markers of subclinical atherosclerosis and arterial stiffness, namely carotid intima-media thickness (CIMT) and the cardio-ankle vascular index (CAVI), among people living with HIV (PLWH) receiving TAF- or TDF-based regimens and ART-naive individuals.
METHODS: In this cross-sectional study, a total of 178 PLWH were included and classified into three groups: TAF-based therapy (n = 79), TDF-based therapy (n = 49), and ART-naive individuals (n = 53). Lipid profiles, CIMT, and CAVI were assessed contemporaneously during antiretroviral treatment and compared across groups. Multivariate logistic regression analysis was performed to identify factors independently associated with increased arterial stiffness.
RESULTS: Total cholesterol, triglyceride levels, CIMT, and CAVI were significantly higher in the TAF group compared with both the TDF and ART-naive groups (all p < 0.05). No significant differences were observed between the TDF and ART-naive groups. Subclinical atherosclerosis (CIMT ≥ 1 mm) and increased arterial stiffness (CAVI ≥ 8) were most frequently observed among individuals receiving TAF. In multivariate analysis, TAF use (p = 0.01) and age (p < 0.001) were independently associated with CAVI ≥ 8.
CONCLUSIONS: Although TAF provides important renal and bone safety advantages, TAF-based regimens were associated with less favorable metabolic parameters and higher subclinical vascular markers in this cross-sectional cohort. These findings should be interpreted cautiously and do not establish a causal relationship.
CLINICAL TRIAL NUMBER: Not applicable.
PMID:42034976 | DOI:10.1186/s12879-026-13377-5