Long-Term Evolution of Renal Function Among People with HIV who Received Tenofovir Alafenamide-Containing Antiretroviral Therapy.

Abstract

Introduction: Among people with HIV (PWH), real-world data on the long-term renal function evolution while receiving tenofovir alafenamide (TAF)-containing antiretroviral therapy (ART) remain scarce.

Methods: PWH who initiated or were switched to TAF-containing ART and controls who received non-tenofovir-containing ART were included for follow-up. We retrospectively collected demographic, clinical, and laboratory data, including estimated glomerular filtration rate (eGFR), urine β-2 microglobulin, and urine protein-to-creatinine ratio (UPCR). The association between the duration of ART exposure and change of eGFR was compared in locally estimated scatterplot smoothing (LOESS) regression. Factors associated with an excess decline of eGFR (defined as a decline > 2.5 ml/min/1.73 m² per year; or > 25% throughout the observation) among TAF-receiving PWH were also evaluated.

Results: Overall, 2422 PWH receiving TAF-containing regimens and 252 controls were included, with the median follow-up duration being 4.8 and 5.4 years, respectively. In the LOESS regression, the predicted change of eGFR at weeks 240 was - 8.0 (95% CI, - 9.1 to - 6.8) ml/min/1.73 m² for TAF group, compared to - 11.1 ml/min/1.73 m² (95% CI, - 15.4 to - 6.7) for non-TAF group. In the TAF group, 183 (7.6%) experienced an excessive renal function decline. Furthermore, the levels of urine β-2 microglobulin and UPCR remained stable throughout the observation. A higher plasma HIV RNA level, old age, presence of clinically significant proteinuria throughout observation, and having a higher eGFR at baseline were associated with an excessive decline of eGFR among TAF-receiving PWH.

Conclusions: Our study suggests that long-term exposure to TAF-containing ART was not associated with augmented eGFR declines among PWH.