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Changes in renal function after switching from TDF to TAF in HIV-infected individuals: a prospective cohort study

Bernard Surial, Bruno Ledergerber, Alexandra Calmy, Matthias Cavassini, Huldrych F Günthard, Helen Kovari, Marcel Stöckle, Enos Bernasconi, Patrick Schmid, Christoph A Fux, Hansjakob Furrer, Andri Rauch, Gilles Wandeler & Swiss HIV Cohort Study

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
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.
   
citation Surial B, Ledergerber B, Calmy A, Cavassini M, Günthard H F, Kovari H, Stöckle M, Bernasconi E, Schmid P, Fux C A, Furrer H, Rauch A, Wandeler G, Swiss HIV Cohort Study . Changes in renal function after switching from TDF to TAF in HIV-infected individuals: a prospective cohort study. J Infect Dis 2020;.
   
type journal paper/review (English)
date of publishing 19-03-2020
journal title J Infect Dis
ISSN electronic 1537-6613
PubMed 32189003
DOI 10.1093/infdis/jiaa125