This article is written live from ID Week 2017 Annual Meeting in San Diego, CA. MPR will be reporting news on the latest findings from leading experts in infectious diseases. Check back for more news from IDWeek 2017.
SAN DIEGO—For HIV-infected patients with declining renal function who are receiving a regimen containing tenofovir disoproxil fumarate (TDF), switching to other antiretroviral agents (ARVs) results in significant recovery of the estimated glomerular filtration rate (eGFR), according to results of a cohort study presented at IDWeek 2017.
The study included 141 HIV-infected patients with renal insufficiency who discontinued TDF and initiated other ARVs. The patients were placed into 2 groups based on their eGFR at the time of switching agents: the early-switch group (eGFR of ≥60mL/min; n=54) and the late-switch group (eGFR <60mL/min; n=87).
Baseline demographics showed that 48.9% of the patients included in the study received NNRTI-based therapy while 51.1% received a PI-based regimen. The median (IQR) length of TDF use was reported as 5.2 years (2.7, 6.9). Of the total patients in the study, 72.3% switched from TDF to abacavir, while the remaining switched to other ARVs.
Mean patient age differed between the two groups (48.6 years vs. 57.9 years for early- and late-switch groups, respectively; P=0.004), as did body weight (mean 59 vs. 55kg; P=0.004).
At the time of TDF switching, the average eGFR was 72.4±13.7mL/min for patients in the early-switch group and 47.0±14.8mL/min for patients in the late-switch group. The study authors reported, “After switching TDF, mean eGFR in early-switch group significantly increased to 84.2±13.5mL/min at 6 months (P=0.001) and 81.8±18.1mL/min at 12 months (P=0.044); mean eGFR in late-switching group significantly increased to 58.5±13.2mL/min (P<0.001) and 60.2±14.3mL/min (P<0.001) at 6 and 12 months, respectively.” One year after switching from TDF to other ARVs, eGFR recovery to ≥90mL/min occurred in 44.4% of patients in the early-switch group and 2.3% of patients in the late-switch group (P<0.001).
For HIV-infected patients with renal insufficiency, eGFR was found to recover when patients discontinued therapy containing TDF and initiated a regimen containing other ARVs. The authors added, “Patients in the early-switch group have a higher chance of renal function recovery to normal eGFR. This may encourage clinicians to switch TDF early before eGFR declining to <60mL/min.”
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Janepiriyaprayoon P, Sungkanuparph S. Recovery of Renal Function after Switching from Tenofovir Disoproxil Fumarate to Other Antiretroviral Agents in HIV-infected Patients with Renal Insufficiency Poster presented at IDWeek; October 4–8, 2017; San Diego, CA. http://www.idweek.org.