Rates and predictors of switching to tenofovir alafenamide-containing ART in a nationwide cohort

Abstract

Background Tenofovir alafenamide (TAF)-containing combinations were introduced in Switzerland after October 2016 and are recommended over tenofovir disoproxil fumarate (TDF) in patients with osteoporosis or impaired renal function. Methods We included all participants of the Swiss HIV Cohort Study on TDF-containing antiretroviral therapy with follow-up visits after January 2016. We determined the proportion of switches from TDF to TAF overall, and among patients with risk factors for TDF toxicity, including osteoporosis, impaired renal function or marked proteinuria. We used multivariable logistic regression to explore predictors of switching from TDF to TAF. Results We included 5′012 patients, of whom 652 (13.0%) had risk factors for TDF toxicity. A switch from TDF to TAF was undertaken in 2′796 (55.8%) individuals overall, and in 465 (71.3%) with risk factors. Predictors of switching to TAF were male sex (adjusted odds ratio 1.27, 95% confidence interval 1.07–1.50), age > 50 years (1.43, 1.23–1.66) and the presence of risk factors for TDF toxicity (2.21, 1.77–2.75). In contrast, patients with a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based single-pill regimen (0.11, 0.09–0.13), those treated in non-tertiary care centers (0.56, 0.46–0.70), as well as those with CD4 cell counts below 500/μL (0.77, 0.66–0.90) and with chronic hepatitis C infection (0.66, 0.54–0.80) were most likely to stay on TDF. Conclusions Over 50% of patients on TDF-containing therapy, including the majority of patients at risk for TDF toxicity, were switched to TAF within two years of its introduction in Switzerland. Individuals on NNRTI-based single-pill regimens were most likely to remain on TDF.

Nephrotoxıcıty in Patıents on Tenofovır vs Non-Tenofovır Contaınıng Art Regımen: An Observatıonal Study

“…Recently a pro-drug formulation of Tenofovir: Tenofovir alafenamide (TAF), has been approved in several countries. as it does not interact with the transport protein required for its accumulation in Renal proximal tubule and therefore leads to less renal toxicity [37,38]. TDF is available in India but was not available through ART centres at the time of study, but is available now.…”

HIV-Associated Cardiovascular Disease Pathogenesis: An Emerging Understanding Through Imaging and Immunology

“…188 In contrast, the HIV Swiss cohort did not find the same risk. 189 INSTIs are still considered less cardiotoxic; however, the excess risk detected in the RESPOND collaboration may represent a bias toward prescribing INSTI-based regimens to patients at higher risk of CVD.…”

Exercise to Prevent Accelerated Vascular Aging in People Living With HIV

“…248,249 However, older nucleoside reverses transcriptase inhibitors (eg, abacavir, zidovudine, and lamivudine) and the non-nucleoside inhibitor efavirenz may increase CVD risk, although associations between these specific drugs and CVD risk is also inconsistent across studies. 116,123,248,250–253 Moreover, contemporary ART drugs such as tenofovir and integrase strand transfer inhibitors cause significant fat mass gain, particularly among women, 254,255 and although the degree to which this contributes to long-term CVD risk is presently unclear, 253,256 modeling studies predict an increase in CVD risk. 257 The protease inhibitors such as ritonavir-boosted darunavir, lopinavir, and atazanavir are largely considered to be the most cardiotoxic, causing hyperlipidemia, insulin resistance, oxidative stress, and cellular senescence that together contribute to increased CVD risk with long-term use.…”

“…Paradoxically, weight gain associated with integrase strand transfer inhibitor use has been observed alongside no changes or a decrease in CVD risk among PLWH. 252,253 Moreover, there is cross-sectional evidence indicating that FMD, CIMT, and soluble inflammatory and vascular adhesion markers are similar among PLWH with and without obesity who are using the same ART regimen. 386 On the other hand, visceral adiposity and epicardial adipose tissue have been shown to be associated with prevalent CVD or atherosclerosis among PLWH in retrospective or cross-sectional cohort studies.…”