This Week in HIV Research: Renal Upsides for Tenofovir Alafenamide

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Stefan Kühn; licensed under CC BY-SA 3.0

HIV research: It does a body good! As we drank in the latest in peer-reviewed HIV science for this week's article, we found a host of studies whose findings are likely to yield benefits for the minds and bodies of our HIV-positive patients and clients. They include new data regarding:

  • The viability of the single-pill E/C/F/TAF regimen in HIV-positive people on chronic hemodialysis.
  • Tenofovir alafenamide's safety in the setting of kidney damage among people who took the prodrug's predecessor.
  • Mental health concerns and critical screening needs among HIV-positive American Indians and Alaskan Natives.
  • The importance of fully appreciating and servicing the parenting desires of people living with HIV.

Let's pour ourselves a hearty glass of research, and help one another grow up to be big and strong HIV care providers. To beat HIV, you have to follow the science!

Barbara Jungwirth is a freelance writer and translator based in New York. Follow Barbara on Twitter: @reliabletran.

Myles Helfand is the executive editor and general manager of TheBody and TheBodyPRO. Follow Myles on Twitter: @MylesatTheBody.

E/C/F/TAF Appears Viable for People on Dialysis

A single-pill regimen containing tenofovir alafenamide (TAF), a prodrug of tenofovir, may be tolerable for people living with HIV who are on chronic hemodialysis, a small multi-center study published in The Lancet found.

Researchers switched 55 HIV-positive, virally suppressed people who had end-stage renal disease from their current antiretroviral regimen to a once-daily regimen of elvitegravir, cobicistat, emtricitabine, and TAF (E/C/F/TAF, Genvoya). All participants had been on chronic hemodialysis for no less than six months prior to joining the study.

Given the generally ill health of study participants, the significantly higher rate of severe adverse events (33% of the 55 participants experienced a grade 3 or higher event by week 48) compared to otherwise healthy people was not unexpected, study authors noted. However, none of those events at or above grade 3 were deemed to be treatment-related. Most such events were instead related to participants’ comorbid conditions, and most treatment-related AEs were less severe (grades 1 and 2).

Study authors concluded that E/C/F/TAF can be used in people with end-stage renal disease. Barcelona, Spain, researchers Juan Ambrosioni, M.D., Ph.D., and José M. Miró, M.D., Ph.D., cautioned in a commentary article that the study did not assess bone health or mitochondrial toxicity, nor were potential drug-drug interactions explored. However, a single tablet regimen for people on dialysis who are waiting for a kidney transplant is a welcome alternative, they concluded.

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TAF OK in Setting of TDF-Related Renal Injury

Tenofovir alafenamide may be safe in people with prior kidney injury, a very small Swiss study published in Open Forum Infectious Diseases concluded.

Ten older people living with HIV (median age 55) who were heavily treatment experienced and whose renal health had suffered after taking a regimen containing tenofovir disoproxil fumarate (TDF) were switched to a regimen containing TAF. All were virally suppressed at the time of the switch. Nine of the 10 participants had significant comorbidities, including cardiovascular issues, bone disease, and chronic hepatitis.

During the first year on TAF, renal function remained stable in all participants, and the proportion with significant proteinuria -- an indication of kidney problems -- dropped from seven people at baseline to three a year later.

Separately, the study found that most participants' lipid profiles worsened after the switch, including in three of four participants who had discontinued TDF months before starting TAF. The lack of lipid-lowering TDF appears not to be the only reason for this metabolic change, researchers concluded. They called for longer-term studies of TAF's effect on renal function, bone mineral density, and plasma lipids.

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American Indian/Alaska Natives Living With HIV Need More Mental Health Screening

Providers caring for American Indians/Alaska Natives living with HIV should screen for mental health issues and offer appropriate referrals, a report published in Morbidity and Mortality Weekly Report recommended.

The report sample included 666 people who self-identified as American Indian/Alaska Native and received HIV care. However, it did not include Indian Health Services facilities or tribal lands. More than half (51%) of these participants lived below the poverty line, 27% reported depressive symptoms, 78% internalized HIV stigma, and 20% binge drinking. Rates of depression (25%) and stigma (79%) in all people living with HIV were similar to those seen among the study’s American Indian/Alaska Native participants.

Overall, HIV diagnoses among this ethnicity increased by 70% between 2011 and 2016, compared to a decline of 5% between 2011-2015 among all people living with HIV. In the report sample, the rate of sustained viral suppression (64%) was similar to that of white people (66%), but significantly below the 80% national HIV prevention goal.

Culturally appropriate HIV, mental health, and peer support services could be provided by community-based and tribal organizations and help improve health outcomes among this group, report authors concluded.

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Reproductive Desires Remain Common Among People With HIV

Around 40% of people living with HIV may want to have children at some point, a survey published in Open Forum Infectious Diseases found.

Researchers surveyed the reproductive desires of 1,425 people in the U.S., 70% of whom were men who have sex with men (MSM), once before they started antiretroviral therapy and again 96 weeks later. Most MSM (86%) had no children; that proportion dropped to 27% among women and heterosexual men, respectively.

The initial survey revealed that 42% of MSM respondents, 37% of men who have sex with women, and 43% of women "may want" to have children; two years later, those proportions were at nearly steady 41%, 37%, and 43%, respectively. HIV treatment seemed to have little effect on the overall statistics; 10% of respondents who hadn’t wanted children at baseline did so two years later, and another 10% had the opposite reaction.

A 2013 Gallup poll found that 74% of all US adults have children -- and 19% of those who don’t have children would want them. People living with HIV should be provided with counseling on contraceptive methods and safe conception, and providers should be aware of resources for MSM who want children, study authors concluded.