Tenofovir alafenamide in multimorbid HIV-infected patients with prior tenofovir-associated renal toxicity. Open Forum Infectious Diseases
Walti et al. aimed to assess in a rea-life setting, whether a switch from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) due to prior TDF-induced renal toxicity is safe and efficacious in multimorbid individuals. In their case series, 10 patients with at least 1 year of follow-up were included in the analysis.
The median age was 55 (53–70) years and at the time of switch all patients had a suppressed HIV virus load with a median CD4 cell count of 688 (437–828) cells/μL. Participants were heavily treatment-experienced (median time on antiretroviral therapy, 19 years) and had numerous changes of drug classes due to virological failure, side effects, and potential long-term toxicity. Nine patients had significant, mostly cardiovascular comorbidities, and 7 had more than 3 comedications. Osteoporosis was documented in 4 patients. Three patients had concomitant chronic hepatitis B virus (HBV) infection, and 2 had a chronic hepatitis C virus (HCV) infection.
After switch from TDF to TAF, renal glomerular function remained stable, with a median change in eGFR (IQR) at 12 months of –0.5 (–3 to +3) mL/min. No Fanconi syndrome or other acute kidney injury was observed during the first year of TAF. Only small changes in tubular markers were seen, and the proportion of patients with a significant proteinuria (>20 mg/mmol) decreased from 70% to 30%.
In conclusion, the findings of this case series support the use of TAF in HIV-monoinfected and HIV/HBV-coinfected patients with severe TDF-related toxicity, but prospective, long-term studies in similar populations are needed to confirm our findings.