Antiretrovirals for People with HIV on Dialysis

Bictegravir/emtricitabine/tenofovir alafenamide in a virologically suppressed adult with HIV and end-stage renal disease on chronic peritoneal dialysis: A case report

“…Even though the rates of RRT in PWH are increasing, data supporting the safe and effective use of these preferred regimens in people on HD or PD is limited. 6 While bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) is FDA-approved for virologically suppressed PWH receiving chronic HD, 7,8 clinical data for HD may not translate to PD due to less drug removal during PD, potentially resulting in drug accumulation and compromising safety. 9 To our knowledge, there are no clinical data on the use of BIC/FTC/TAF in PD.…”

“…>1000 Daltons), highly protein bound, and highly distributed in the tissues will evade clearance by PD. 6,10,11 Lipophilic drugs typically have less dialyziblity, unless a concentration gradient exists between the serum and dialysate, then highly lipophilic molecules will pass from the serum to dialysate more easily. However, if the molecule concentrates intracellularly, like most ARVs, then the gradient will be less clinically relevant.…”

“…However, if the molecule concentrates intracellularly, like most ARVs, then the gradient will be less clinically relevant. 6,12 The physiochemical characteristics of ARVs commonly used in RRT, with a focus on ARVs available as single tablet regimens (STRs), are described in Table 1. Comparatively, BIC/FTC/TAF has favorable physiochemical properties that should balance removal and therapeutic concentrations, supporting its use in PD.…”

“…Even though the rates of RRT in PWH are increasing, data supporting the safe and effective use of these preferred regimens in people on HD or PD is limited. 6…”

“…However, if the molecule concentrates intracellularly, like most ARVs, then the gradient will be less clinically relevant. 6,12…”