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Tenofovir Alafenamide (TAF) in People With Kidney Dysfunction

October/November 2015

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No Initial Use of TDF but Using TAF

Among participants who had not been taking TDF but were instead taking other nukes at the start of the study, 29% had high levels of protein in their urine. After these participants switched their regimens to TAF, 48 weeks later the proportion with a high level of protein in their urine was 22%. This difference was not statistically significant.

These changes confirm that TDF can play a major role in kidney injury and that switching to TAF may greatly reduce the severity of kidney injury in some patients.


A Focus on Albumin

Another way to assess kidney injury is to measure the levels of a specific protein -- albumin -- in the urine.

The distribution of elevated albumin levels among participants who entered the study using TDF was as follows:

  • at the start of the study -- 55% had elevated albumin levels in their urine
  • after being on TAF for 48 weeks -- 22% had elevated levels of albumin in their urine
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This difference in albumin levels was statistically significant. Thus, there may be a role for replacing TDF with TAF in people with kidney injury.

In contrast, among participants who used nukes other than TDF at the start of the study and then exchanged these nukes for TAF, there was little change in elevated albumin levels. Among these participants, the distribution of elevated albumin levels was as follows:

  • at the start of the study -- 37% had elevated albumin levels in their urine
  • after being on TAF for 48 weeks -- 34% had elevated levels of albumin in their urine


Changes in Bone Mineral Density

The following changes in bone mineral density occurred during the study:

Spine

  • participants who switched from TDF to TAF -- an increase of 2.3%
  • participants who switched from another nuke to TAF -- an increase of 1%

Hips

  • participants who switched from TDF to TAF -- an increase of 1.5%
  • participants who switched from another nuke to TAF -- an increase of 0.7%


Changes in Lipids

As with other studies, participants who switched from TDF to TAF generally had an increase in their fasting lipid levels, including the following:

  • total cholesterol
  • bad cholesterol (LDL-C)
  • good cholesterol (HDL-C)
  • triglycerides

Participants who switched to TAF from a nuke other than TDF had modest decreases in their lipid levels.


Key Points

Switching from a regimen based on TDF to TAF resulted in improvements in assessments of kidney and bone health.

Participants who were not using a TDF-based regimen who switched to TAF did not have significant changes in assessments of kidney or bone health. However, their lipid levels decreased somewhat.

Overall, the data from the present study suggest that people who are encountering kidney dysfunction while taking a TDF-based regimen can generally expect improvement when they switch to a TAF-based regimen. Note that not every participant who switched to a TAF-based regimen had such an improvement.


Reference

Gupta S, Pozniak A, Arribas J, et al. Subjects with renal impairment switching from tenofovir disoproxil fumarate to tenofovir alafenamide have improved renal and bone safety through 48 weeks. In: Program and abstracts of the 8th IAS Conference on HIV Pathogenesis, Treatment and Prevention, 19-22 July 2015, Vancouver, Canada. Abstract TUAB0103.

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Related Stories

Genvoya, New Single-Tablet HIV Regimen Containing Tenofovir Alafenamide, Approved By FDA
Tenofovir Alafenamide (TAF) Still Noninferior to Current Tenofovir -- With Better Bone/Kidney Signals



This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication TreatmentUpdate. Visit CATIE's Web site to find out more about their activities, publications and services.
 


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