Effects of switching antiretroviral therapy from ACRIPTEGA (TLD) to KOCITAF on renal function recovery in people living with HIV and acute kidney injury: a prospective observational study at Thasala Hospital, Nakhon Si Thammarat Province

Abstract

This study aimed to assess the effects of switching from ACRIPTEGA (tenofovir disoproxil fumarate, lamivudine, dolutegravir; TLD) เป็น KOCITAF (tenofovir alafenamide fumarate, emtricitabine, dolutegravir) on renal function recovery in people living with HIV (PLHIV) who developed acute kidney injury (AKI). A prospective observational study was conducted at Thasala Hospital, Nakhon Si Thammarat Province, between June 2024 and May 2025. Medical records of 520 PLHIV were reviewed. Thai patients aged ≥ 18 years who had received TLD for at least 6 months and met the criteria for declined renal function (eGFR <60 mL/min/1.73 m² or serum creatinine >1.2 mg/dL) were screened. A total of 65 eligible patients who were switched from TLD to KOCITAF and followed up at months 1, 3, and 6. eGFR and serum creatinine were assessed before switching (baseline) and after switching at months 1, 3, and 6. Changes in renal function were analyzed using repeated-measures ANOVA, and factors associated with renal recovery were analyzed using multivariate logistic regression. The 65 participants were predominantly male (63.11%), with a mean age of 54.08±11.08 years. Before switching, the mean eGFR was 48.32±11.35 mL/min/1.73 m², and the mean serum creatinine level was 1.58±0.79 mg/dL. After switching to KOCITAF, the mean eGFR significantly increased to 58.21±18.93 mL/min/1.73 m², while the mean serum creatinine level decreased to 1.32±0.37 mg/dL within 6 months (p<0.05). Pairwise comparisons showed that eGFR was significantly higher at all post-switch follow- up time points (months 1,3, and 6) compared with the TLD period, whereas no statistically significant differences were observed among the post switch time points. The mean CD4 count increased from 631.98±464.45 to 960.28±304.36 cells/µL indicating that the regimen switch did not compromise immunological efficacy. Factors significantly associated with renal recovery included baseline eGFR >70 mL/min/1.73m², duration TLD use ≤24 months, no prior use of TDF-containing antiretroviral regimens before starting TLD, and absence of weight loss exceeding 3 kg (p<0.05). In conclusion, switching antiretroviral therapy from TLD to KOCITAF was associated with significant renal function improvement in renal function without compromising immunologic outcomes. These findings support the preferential use of TAF-based regimens over TDF-based regimens in PLHIV who are at risk of renal complications.