Bernard Surial1, Bruno Ledergerber2, Alexandra Calmy3, Matthias Cavassini4, Huldrych F Günthard2,5, Helen Kovari2, Marcel Stöckle6, Enos Bernasconi7, Patrick Schmid8, Christoph A Fux9, Hansjakob Furrer1, Andri Rauch1, Gilles Wandeler1,10. 1. Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland. 2. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. 3. Division of Infectious Diseases, Geneva University Hospital, University of Geneva, Geneva, Switzerland. 4. Division of Infectious Diseases, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland. 5. Institute of Medical Virology, University of Zurich, Zurich, Switzerland. 6. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland. 7. Division of Infectious Diseases, Regional Hospital of Lugano, Lugano, Switzerland. 8. Division of Infectious Diseases, Cantonal Hospital of St Gallen, St Gallen, Switzerland. 9. Division of Infectious Diseases, Cantonal Hospital of Aarau, Aarau, Switzerland. 10. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Abstract
BACKGROUND: Replacing tenofovir disoproxil fumarate (TDF) with tenofovir alafenamide (TAF) improves renal tubular markers in HIV-infected individuals but the impact on estimated glomerular filtration rate (eGFR) remains unclear. METHODS: In all participants from the Swiss HIV Cohort Study who switched from TDF to TAF-containing antiretroviral regimen or continued TDF, we estimated changes in eGFR and urine protein-to-creatinine ratio (UPCR) after 18 months using mixed-effect models. RESULTS: Of 3520 participants (26.6% women, median age 50 years), 2404 (68.5%) switched to TAF. Overall, 1664 (47.3%) had an eGFR <90 mL/min and 1087 (30.9%) an UPCR ≥15 mg/mmol. In patients with baseline eGFR ≥90 mL/min, eGFR decreased with the use of TDF and TAF (-1.7 mL/min). Switching to TAF was associated with increases in eGFR of 1.5 mL/min (95% confidence interval [CI], .5-2.5) if the baseline eGFR was 60-89 mL/min, and 4.1 mL/min (95% CI, 1.6-6.6) if <60 mL/min. In contrast, eGFR decreased by 5.8 mL/min (95% CI, 2.3-9.3) with continued use of TDF in individuals with baseline eGFR <60 mL/min. UPCR decreased after replacing TDF by TAF, independent of baseline eGFR. CONCLUSIONS: Switching from TDF to TAF improves eGFR and proteinuria in patients with renal dysfunction.
BACKGROUND: Replacing tenofovir disoproxil fumarate (TDF) with tenofovir alafenamide (TAF) improves renal tubular markers in HIV-infected individuals but the impact on estimated glomerular filtration rate (eGFR) remains unclear. METHODS: In all participants from the Swiss HIV Cohort Study who switched from TDF to TAF-containing antiretroviral regimen or continued TDF, we estimated changes in eGFR and urine protein-to-creatinine ratio (UPCR) after 18 months using mixed-effect models. RESULTS: Of 3520 participants (26.6% women, median age 50 years), 2404 (68.5%) switched to TAF. Overall, 1664 (47.3%) had an eGFR <90 mL/min and 1087 (30.9%) an UPCR ≥15 mg/mmol. In patients with baseline eGFR ≥90 mL/min, eGFR decreased with the use of TDF and TAF (-1.7 mL/min). Switching to TAF was associated with increases in eGFR of 1.5 mL/min (95% confidence interval [CI], .5-2.5) if the baseline eGFR was 60-89 mL/min, and 4.1 mL/min (95% CI, 1.6-6.6) if <60 mL/min. In contrast, eGFR decreased by 5.8 mL/min (95% CI, 2.3-9.3) with continued use of TDF in individuals with baseline eGFR <60 mL/min. UPCR decreased after replacing TDF by TAF, independent of baseline eGFR. CONCLUSIONS: Switching from TDF to TAF improves eGFR and proteinuria in patients with renal dysfunction.
Authors: Sarah M Michienzi; Mikayla Johnson; Thomas D Chiampas; Eric Wenzler; Rodrigo M Burgos; Renata O Smith; Melissa E Badowski Journal: Drugs Context Date: 2021-07-23