A 32-year-old transgender woman presents for routine follow-up for gender-affirming care and management of HIV. She was diagnosed with HIV 4 years ago, at which time the baseline drug resistance genotype showed no resistance mutations. Baseline laboratory studies also showed positive hepatitis B surface antigen. She took elvitegravir-cobicistat-tenofovir DF-emtricitabine for 3 years and then 1 year ago switched to bictegravir-tenofovir alafenamide-emtricitibine. She has persistently undetectable levels of HIV RNA levels and HBV DNA on this regimen, but she has gained approximately 15 pounds in the past year. She is very concerned that tenofovir alafenamide is playing a role in her weight gain and has requested a new regimen that does not include tenofovir alafenamide.