A switch to TAF-based cART more common than dual therapy

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A consistent proportion of people with HIV are switching from tenofovir disoproxil fumarate (TDF)-based therapy to other alternative regimens, according to a study by researchers at National Institute for Infectious Diseases ‘L Spallanzani’, San Raffaele Scientific Institute, IRCCS Ca’ Granda Ospedale Maggiore Policlinico Foundation, University of Milan, Sapienza University of Rome, University of Bari Aldo Moro, University of Sassari, University of Palermo, University of Genoa, and University College London.

People with HIV can achieve and maintain a lifetime of viral suppression with the combination antiretroviral therapy (cART) currently available. Guidelines recommend the use of a 3-drug combination regimen when switching patients who have suppressed viral loads, have never experienced virologic failure, and have no evidence of drug resistance.

Growing evidence suggests some dual-therapy regimens (DT) may also optimally maintain virologic suppression. A goal while switching from TDF-based therapy is to decrease short- or long-term toxicity; TDF is associated with mild renal impairment and could progress to nephrotoxicity.

Study authors conclude the “analysis shows that a consistent proportion of people with a VL ≤50 copies/mL in recent years have been switched from TDF to alternative strategies,” with a switch to TAF-based cART more common than DT.

Abstract
Our aim was to evaluate the association between recent eGFR values and risk of switching from TDF to TAF or dual therapy (DT) in real life. HIV-positive patients achieving HIV-RNA ≤50 copies/mL for the first time after starting a TDF-based regimen were included. Kaplan–Meier (KM) curves and Cox regression models were used to estimate the time from TDF to switch to TAF or DT. 1486 participants were included: median (IQR) age 36 (30–42) years; baseline CKD-EPI eGFR 99.92 (86.47–111.4) mL/min/1.73m2. We observed a consistently higher proportion of people with HIV-RNA ≤50 copies/mL who switched from TDF to TAF rather than to DT. By competing risk analysis, at 2 years from baseline, the probability of switching was 3.5% (95% CI 2.6–4.7%) to DT and 46.7% (42.8–48.5%) to TAF. A significantly higher probability of switching to TAF was found for patients receiving INSTI at baseline versus NNRTIs and PI/b [KM, 65.6% (61.7–69.4%) vs. 4.0% (1.8–6.1%) and 59.9% (52.7–67.2%), respectively; P < 0.0001]. eGFR <60 mL/min/1.73m2 both as time-fixed covariate at baseline or as current value was associated with a higher risk of switching to DT [aHR 6.68 (2.69–16.60) and 8.18 (3.54–18.90); P < 0.001] but not to TAF-based cART [aHR 0.94 (0.39–2.31), P = 0.897; and 1.19 (0.60–2.38), P = 0.617]. Counter to our original hypothesis, current eGFR is used by clinicians to guide switches to DT but does not appear to be a key determinant for switching to TAF.

Authors
A Vergori, R Gagliardinia, N Gianottib, A Goric, M Lichtnerd, A Saracinoe, A De Vitof, A Casciog, A Di Biagioh, A d’Arminio Monfortei, A Antinoria, A Cozzi-Lepril, ICONA Foundation Study Network

 

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Journal of Antimicrobial Agents abstract

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