Our aim was to evaluate the association between most recent eGFR values and the risk ofswitching from TDF to TAF or to dual therapy (DT) separately for the two strategies in a reallifesetting. HIV-positive patients, achieving HIV-RNA≤50 copies/ml for the first time afterstarting a TDF-based regimen (baseline) were included. Kaplan-Meier (KM) curves and Coxregression models were used to estimate the time from TDF to switch to TAF or DT. A total of1,486 participants were included: median (IQR) age 36y(30-42), baseline CKD-EPI eGFR 99.92(86.47,111.4) mL/min/1.73m2. We observed a consistently higher proportion of people with aHIV-RNA≤50copies/mL who have switched from TDF to TAF rather than to DT. By competingrisk analysis, the 2 years from baseline, the probability of switching was 3.5% (95% CI 2.6-4.7) to DT and 46.7% (95% CI 42.8-48.5) to TAF. A significant higher probability of switchingto TAF was found for patients receiving INSTI at baseline versus NNRTIs and PI/b (KM:65.6%, 95%CI 61.7, 69.4; vs. 4.0%, 95%CI 1.8, 6.1 and 59.9%, 95%CI 52.7, 67.2, respectively;p<.0001). A eGFR<60 ml/min/1.73m2 both as time-fixed covariate at baseline or as currentvalue, was associated with a higher risk of switching to DT [aHR 6.68, 95%CI 2.69, 16.60 and8.18, 95% CI 3.54, 18.90; p-value <0.001] but not to TAF-based cART [aHR= 0.94, 95%CI0.39, 2.31, p=0.897 and 1.19, 95%CI 0.60, 2.38, p=0.617)]. In conclusion, counter to our originalhypothesis, current eGFR value is used by clinician to guide switches to DT but does not seemsto be a key determinant for switching to TAF. This should be taken into account when managingpeople on TAF-based regimens.

Switching from TDF to TAF or dual therapy (DT)-based regimens in HIV-infected in individuals with viral load <=50 copies/ml: does eGFR matter?

G. Nunnari;
2020-01-01

Abstract

Our aim was to evaluate the association between most recent eGFR values and the risk ofswitching from TDF to TAF or to dual therapy (DT) separately for the two strategies in a reallifesetting. HIV-positive patients, achieving HIV-RNA≤50 copies/ml for the first time afterstarting a TDF-based regimen (baseline) were included. Kaplan-Meier (KM) curves and Coxregression models were used to estimate the time from TDF to switch to TAF or DT. A total of1,486 participants were included: median (IQR) age 36y(30-42), baseline CKD-EPI eGFR 99.92(86.47,111.4) mL/min/1.73m2. We observed a consistently higher proportion of people with aHIV-RNA≤50copies/mL who have switched from TDF to TAF rather than to DT. By competingrisk analysis, the 2 years from baseline, the probability of switching was 3.5% (95% CI 2.6-4.7) to DT and 46.7% (95% CI 42.8-48.5) to TAF. A significant higher probability of switchingto TAF was found for patients receiving INSTI at baseline versus NNRTIs and PI/b (KM:65.6%, 95%CI 61.7, 69.4; vs. 4.0%, 95%CI 1.8, 6.1 and 59.9%, 95%CI 52.7, 67.2, respectively;p<.0001). A eGFR<60 ml/min/1.73m2 both as time-fixed covariate at baseline or as currentvalue, was associated with a higher risk of switching to DT [aHR 6.68, 95%CI 2.69, 16.60 and8.18, 95% CI 3.54, 18.90; p-value <0.001] but not to TAF-based cART [aHR= 0.94, 95%CI0.39, 2.31, p=0.897 and 1.19, 95%CI 0.60, 2.38, p=0.617)]. In conclusion, counter to our originalhypothesis, current eGFR value is used by clinician to guide switches to DT but does not seemsto be a key determinant for switching to TAF. This should be taken into account when managingpeople on TAF-based regimens.
2020
HIV
Tenofovir alafenamide
Tenofovir disoproxil fumarate
Antiretroviral therapy
Switch
eGFR
dual therapy
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11769/552164
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