Candidates for inclusion in a universal antiretroviral regimen: tenofovir alafenamide

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Purpose of reviewTenofovir disoproxil fumarate (TDF) is a standard first-line therapy for HIV. Recently, tenofovir alafenamide (TAF), a different prodrug for the same active moiety, has been approved. In this review, we have conducted a meta-analysis comparing efficacy and safety data for TDF and TAF, to inform a discussion of which drug would be best for a proposed ‘universal antiretroviral (ARV) regimen’.Recent findingsWe identified 10 randomized controlled trials comparing TDF with TAF (6969 patients, 8043 patient-years of follow-up). Meta-analysis found no difference in treatment efficacy, resistance, or adverse events. There were significant differences favouring TAF in bone mineral density measures and renal function measures, but no significant difference in bone fracture events or discontinuations because of bone toxicity or renal toxicity. TAF arms showed higher lipid levels, and were associated with a slightly greater risk of being started on lipid-lowering therapy.SummaryTAF has lesser detrimental effects on renal and bone markers, but no difference in adverse events. Data are unavailable for TAF safety in pregnancy, tuberculosis coinfection, and low CD4+ count. Data for these groups, and an affordable price, will be required before it can be recommended as part of a ‘universal ARV regimen’.

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