Switching from TDF to TAF in HIV/HBV co-infected individuals with renal dysfunction – a prospective cohort study. JAIDS
Surial et al. aimed to evaluate the impact of replacing tenofovir disoproxil fumarate (TDF) with Tenofovir alafenamide (TAF) on estimated glomerular filtration rate (eGFR), urine protein-to-creatinine ratio, and alanine aminotransferase (ALT) levels in HIV/hepatitis B virus (HBV-) coinfected individuals with renal dysfunction using data from the Swiss HIV Cohort Study (SHCS).
The authors included all participants from the SHCS with an HIV/HBV coinfection who switched from TDF to TAF and had an estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2 and a suppressed HIV viral load (<200 cp/mL). They assessed changes in eGFR, urine protein-to-creatinine ratio, and ALT after 1 year.
Among 106 participants (15.1% women, median age 53 years), eGFR was 60–89 mL/min/1.73 m2 in 84 (79.2%) and <60 mL/min/1.73 m2 in 22 (20.8%) individuals at the time of switch. One year after the switch from TDF to TAF, individuals with an eGFR between 60 and 89 mL/min/1.73 m2 experienced increases in eGFR of 3.2 mL/min/1.73 m2 (95% confidence interval [CI] 1.2 to 5.2), whereas those with an eGFR <60 mL/min/1.73 m2 experienced improvements of 6.2 mL/min/1.73 m2 (95% CI 2.4 to 10.0). Urine protein-to-creatinine ratio decreased overall (26.3 mg/mmol, 95% CI 210.0 to 22.7), and ALT levels declined in patients with elevated baseline levels (211.8 IU/L, 95% CI 217.3 to 26.4) 1 year after replacing TDF with TAF.
In conclusion, switching from TDF to TAF among HIV/HBV coinfected individuals with renal impairment led to improvements in eGFR, a decline in proteinuria, and to ALT normalization in those with elevated ALT levels. The use of TAF in those individuals seems to be safe and effective, and switching from TDF to TAF should be considered among coinfected individuals with renal impairment or with otherwise unexplained ALT elevations.