Recovery of Renal Function After Switching From Tenofovir DF
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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.