Cardiac Events Significantly Higher With TAF vs TDF Treatment for HIV

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The occurrence of cardiac events in a cohort of patients with HIV was significantly higher in patients treated with tenofovir-alafenamide.

The occurrence of cardiac events in a cohort of patients with HIV was significantly higher in patients treated with tenofovir-alafenamide (TAF) compared with those treated with tenofovir disoproxil fumarate (TDF) or non-tenofovir regimens, according to study results presented at the virtual Conference on Retroviruses and Opportunistic Infections, held from March 8 to 11, 2020.

In this retrospective cohort study, researchers studied all cardiac events in patients with HIV (N=2985) from January 1, 2016, to May 31, 2018. Patients were divided into 3 mutually exclusive groups: patients treated with TAF (n=1537), patients treated with TDF (n=1170), and patients not treated with TAF or TDF (non-tenofovir group, n=278). Cardiac events were defined as myocardial infarction, angina pectoris, cardiomyopathy, and arrhythmia. Researchers used hazard ratios (HRs) adjusted for age, previous cardiac history, body mass index, gender, and smoking status.

There were significantly more cardiac events in the TAF group compared with the non-tenofovir group (43 of 1537 vs 11 of 278; HR, 3.86; 95% CI, 1.51-9.82; P =.005); a similar result was found compared with the TDF group (43 of 1537 vs 58 of 1170; HR, 1.94; 95% CI, 1.05-3.57; P =.034). Compared with the patients receiving TDF, patients receiving TAF had significantly more cases of arrhythmia (HR, 4.14; 95% CI, 1.06-16.20; P =.041) as well as more cases of angina pectoris (HR, 1.45; 95% CI, 0.53-3.95; P =.47), cardiomyopathy (HR, 4.50; 95% CI, 0.37-54.55; P =.237), and myocardial infarction (HR, 1.02; 95% CI, 0.32-3.21; P =.975).

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This study was limited by its older population with more cardiac history compared with registration trials. Further, follow-up was short, and the rate of cardiac events was low.

These findings demonstrate that there was a significantly higher occurrence of cardiac events with TAF compared with TDF and non-tenofovir. Researchers stressed that these observations need to be confirmed in larger cohorts. They also suggested that it may be safer to advise older patients with a history of cardiac events about the use of TAF.


Appelman B, van den Berk M, de Regt N, et al. Cardiac events in HIV-infected patients who use tenofovir-Alafenamide. Presented at: Conference on Retroviruses and Opportunistic Infections (CROI); March 8-11, 2020; Accessed March 19, 2020.