Changes in Renal Function After Switching From TDF to TAF in HIV-Infected Individuals: A Prospective Cohort Study
Bernard Surial, Bruno Ledergerber, Alexandra Calmy, Matthias Cavassini, Huldrych F. Günthard, Helen Kovari, M Stöckle, Enos Bernasconi, Patrick Schmid, Christoph A. Fux, Hansjakob Furrer, Andri Rauch, Gilles Wandeler, Swiss HIV Cohort Study, A Anagnostopoulos, Manuel Battegay, Enos Bernasconi, J Böni, Dominique L. Braun, Heiner C. Bucher, Alexandra Calmy, Matthias Cavassini, Angela Ciuffi, G Dollenmaier, Matthias Egger, Luigia Elzi, Jan Fehr, Jacques Fellay, Hansjakob Furrer, Christoph A. Fux, Huldrych F. Günthard, David Haerry, Barbara Hasse, Hans H. Hirsch, Matthias Hoffmann, Irène Hösli, M Huber, Christian R. Kahlert, Laurent Kaiser, Olivia Keiser, Thomas Klimkait, Roger D. Kouyos, Helen Kovari, Bruno Ledergerber, G Martinetti, Begoña Martínez de Tejada, Catia Marzolini, Karin J. Metzner, N Müller, Dunja Nicca, P Paioni, G Pantaleo, Matthieu Perreau, Andri Rauch, Christoph Rudin, Alexandra Scherrer, Patrick Schmid, Roberto F. Speck, M Stöckle, Philip Tarr, Alexandra Trkola, Pietro Vernazza, Gilles Wandeler, Rainer Weber, Sabine Yerly
Abstract
BACKGROUND: Replacing tenofovir disoproxil fumarate (TDF) with tenofovir alafenamide (TAF) improves renal tubular markers in HIV-infected individuals but the impact on estimated glomerular filtration rate (eGFR) remains unclear. METHODS: In all participants from the Swiss HIV Cohort Study who switched from TDF to TAF-containing antiretroviral regimen or continued TDF, we estimated changes in eGFR and urine protein-to-creatinine ratio (UPCR) after 18 months using mixed-effect models. RESULTS: Of 3520 participants (26.6% women, median age 50 years), 2404 (68.5%) switched to TAF. Overall, 1664 (47.3%) had an eGFR <90 mL/min and 1087 (30.9%) an UPCR ≥15 mg/mmol. In patients with baseline eGFR ≥90 mL/min, eGFR decreased with the use of TDF and TAF (-1.7 mL/min). Switching to TAF was associated with increases in eGFR of 1.5 mL/min (95% confidence interval [CI], .5-2.5) if the baseline eGFR was 60-89 mL/min, and 4.1 mL/min (95% CI, 1.6-6.6) if <60 mL/min. In contrast, eGFR decreased by 5.8 mL/min (95% CI, 2.3-9.3) with continued use of TDF in individuals with baseline eGFR <60 mL/min. UPCR decreased after replacing TDF by TAF, independent of baseline eGFR. CONCLUSIONS: Switching from TDF to TAF improves eGFR and proteinuria in patients with renal dysfunction.