Background: 

Whereas tenofovir disoproxil fumarate (TDF) can lead to renal adverse events, tenofovir alafenamide (TAF) has a more favorable renal safety profile. However, the impact of replacing TDF with TAF on renal function and liver parameters among HIV/hepatitis B virus (HBV)-coinfected individuals with renal dysfunction remains unclear.

Methods: 

We included all participants from the Swiss HIV Cohort Study with an HIV/HBV coinfection who switched from TDF to TAF and had an estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m² and a suppressed HIV viral load (<200 cp/mL). We assessed changes in eGFR, urine protein-to-creatinine ratio, and alanine aminotransferase (ALT) after 1 year using mixed-effect models with interrupted time series.

Results: 

Among 106 participants (15.1% women, median age 53 years), eGFR was 60–89 mL/min/1.73 m² in 84 (79.2%) and <60 mL/min/1.73 m² in 22 (20.8%) individuals at the time of switch. One year after the switch from TDF to TAF, individuals with an eGFR between 60 and 89 mL/min/1.73 m² experienced increases in eGFR of 3.2 mL/min/1.73 m² (95% confidence interval [CI] 1.2 to 5.2), whereas those with an eGFR <60 mL/min/1.73 m² experienced improvements of 6.2 mL/min/1.73 m² (95% CI 2.4 to 10.0). Urine protein-to-creatinine ratio decreased overall (−6.3 mg/mmol, 95% CI −10.0 to −2.7), and ALT levels declined in patients with elevated baseline levels (−11.8 IU/L, 95% CI −17.3 to −6.4) 1 year after replacing TDF with TAF.

Conclusions: 

Switching from TDF to TAF among HIV/HBV-coinfected individuals with renal impairment led to improvements in eGFR, a decline in proteinuria, and to ALT normalization in those with elevated ALT levels.

中文翻译：

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简要报告：一项针对HIV / HBV合并感染的肾功能不全患者从TDF转变为TAF的一项前瞻性队列研究

背景： 

替诺福韦二富马酸富马酸盐（TDF）可能导致肾脏不良事件，而替诺福韦阿拉芬酰胺（TAF）具有更有利的肾脏安全性。然而，用TAF替代TDF对感染了HIV / B型肝炎病毒（HBV）的肾功能不全患者的肾功能和肝参数的影响尚不清楚。

方法： 

我们纳入了来自瑞士HIV队列研究的所有HIV / HBV合并感染的参与者，他们从TDF转换为TAF，并且估计的肾小球滤过率（eGFR）<90 mL / min / 1.73 m ²和受抑制的HIV病毒载量（<200 cp / mL）。我们使用时间序列中断的混合效应模型评估了一年后eGFR，尿蛋白与肌酐之比和丙氨酸氨基转移酶（ALT）的变化。

结果： 

在106名参与者中（15.1％，女性，中位年龄53岁），在84名（79.2 ％）个体中eGFR为60-89 mL / min / 1.73 m ²，在22名个体（20.8％）中eGFR为<60 mL / min / 1.73 m ²。切换时间。从TDF转换为TAF一年后，eGFR在60至89 mL / min / 1.73 m ²之间的人的eGFR增加了3.2 mL / min / 1.73 m ²（95％置信区间[CI] 1.2至5.2） ，而eGFR <60 mL / min / 1.73 m ^2的人改善了6.2 mL / min / 1.73 m ²（95％CI 2.4到10.0）。基线水平升高的患者尿蛋白/肌酐之比总体下降（-6.3 mg / mmol，95％CI -10.0至-2.7），ALT水平下降（-11.8 IU / L，95％CI -17.3至- 6.4）用TAF替换TDF后1年。

结论： 

在患有肾功能不全的HIV / HBV合并感染的个体中，从TDF转换为TAF可导致eGFR改善，蛋白尿减少以及ALT水平升高的患者ALT正常化。