Switching from tenofovir containing regimens to boosted protease inhibitor monotherapy: Impact on renal function.
OBJECTIVE
To evaluate the effect on creatinine clearance (CG-CrCl, Cockcroft-Gault equation) of switching to boosted protease inhibitor (PI) monotherapy in patients receiving a triple drug antiretroviral regimen containing TDF.


METHODS
All patients who had received a TDF-containing regimen for at least one year and had been switched to PI monotherapy were included. A rapid decrease in CG-CrCl during exposure to TDF was defined as a decrease in CG-CrCl at least five times higher than the expected due to age (0.4ml/min/year by the years of exposure to TDF). In this subgroup of patients, we considered improvement if the last value of CG-CrCl on PI monotherapy was 10% higher than the last value of CG-CrCl before switching to PI monotherapy. A multivariate logistic regression was constructed to identify factors associated to renal improvement after switching to bPI monotherapy.


RESULTS
64 patients included. The median (IQR) annual change in CG-CrCl during PI monotherapy was significantly lower than the median (IQR) annual change while exposed to TDF [-0.9 (-4.7 to +2.8) ml/min vs. -4 (-8 to -1) ml/min, p=0.001]. 44 patients experienced a rapid decline during TDF exposition. After switch to PI monotherapy, 15/44 (34%, 95% CI: 21-50%) had an improved CG-CrCl and 16/44 (36%, CI 23-52%) experienced a further decline in CG-CrCl. The only variable associated to CG-CrCl improvement was a more rapid CG-CrCl decline in the last year of exposure to TDF.


CONCLUSIONS
Switching to PI monotherapy partially reversed CG-CrCl decrease associated to TDF use, especially in patients with a more rapid decline while receiving TDF.
HIV Unit, Internal Medicine Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain. Electronic address: miriam.estebanez@salud.madrid.org.
Miriam
M
Estébanez
HIV Unit, Internal Medicine Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
Jose I
JI
Bernardino
HIV Unit, Internal Medicine Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
Lucía
L
Serrano
HIV Unit, Internal Medicine Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
Ignacio
I
Pérez-Valero
HIV Unit, Internal Medicine Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
Francisco X
FX
Zamora
HIV Unit, Internal Medicine Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
Maria L
ML
Montes-Ramírez
HIV Unit, Internal Medicine Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
Juan J
JJ
González-García
HIV Unit, Internal Medicine Service, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
Jose R
JR
Arribas
D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003404:Creatinine / Q000378:metabolism; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000378:metabolism; D008297:Male; D011480:Protease Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D000068698:Tenofovir / Q000009:adverse effects / Q000627:therapeutic use*
D019380:Anti-HIV Agents; D011480:Protease Inhibitors; D000068698:Tenofovir; D003404:Creatinine
HIV; Monoterapia; Monotherapy; Renal toxicity; Reversibilidad; Reversibility; Tenofovir; Toxicidad renal; VIH