期刊
JOURNAL OF INFECTIOUS DISEASES
卷 222, 期 4, 页码 637-645出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jiaa125
关键词
tenofovir alafenamide; estimated glomerular filtration rate; urine protein-to-creatinine ratio; renal tubulopathy; antiretroviral therapy; comorbidities; switch
资金
- Swiss National Science Foundation [177499, 842, PP00P3_176944]
- Swiss National Science Foundation (SNF) [PP00P3_176944] Funding Source: Swiss National Science Foundation (SNF)
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.
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