Publikation
Changes in renal function after switching from TDF to TAF in HIV-infected individuals: a prospective cohort study
Wissenschaftlicher Artikel/Review - 19.03.2020
Surial Bernard, Wandeler Gilles, Rauch Andri, Furrer Hansjakob, Fux Christoph A, Schmid Patrick, Bernasconi Enos, Stöckle Marcel, Kovari Helen, Günthard Huldrych F, Cavassini Matthias, Calmy Alexandra, Ledergerber Bruno, Swiss HIV Cohort Study
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Kurzbeschreibung/Zielsetzung
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
We included all participants from the Swiss HIV Cohort Study who switched from a TDF to a 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 3'520 participants (26.6% women, median age 50 years), 2'404 (68.5%) switched to TAF. Prior to switch, 1'664 (47.3%) had an eGFR <90 mL/min, and 1'087 (30.9%) a UPCR ≥15 mg/mmol. In patients with a 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% CI 0.5-2.5) 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 the continued use of TDF in individuals with a 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.