Renal Function Effect of ARV Combination Regimen Tenofovir/Lamivudine/Dolutegravir and Tenofovir/Emtricitabine/Rilpivirine in HIV Patients
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Abstract
BACKGROUND: In 2022, Thailand changed its primary antiretroviral therapy (ART) recommendation from Tenofovir disoproxil fumarate/Emtricitabine/Efavirenz (TEEVIR) to Tenofovir disoproxil fumarate/Lamivudine/Dolutegravir (TLD) due to the superior HIV viral suppression efficacy of TLD compared to TEEVIR. Since the regimen change, however, TLD has been found to cause increased creatinine levels. Tenofovir disoproxil fumarateemtricitabine (TENO-EM)+Rilpivirine (RPV) is another antiretroviral regimen that has been used due to its fewer side effects and less frequent elevation of creatinine levels.
OBJECTIVES: To compare the mean changes in the estimated glomerular filtration rate (eGFR) after switching from the original regimen (TEEVIR) to TLD and TENO-EM+RPV at 12, 24, and 48 weeks.
METHODS: A retrospective cohort study of HIV-infected patients who had previously received ART and achieved viral suppression at Maharat Nakhon Ratchasima Hospital from January 2022 to December 2023 was carried out. Data were retrieved from medical records and analyzed for changes in eGFR using Generalized Estimating Equations.
RESULTS: A total of 212 HIV-infected patients visited the outpatient clinic at Maharat Nakhon Ratchasima Hospital, with 78 receiving TLD, and 134 receiving TENO-EM+RPV. The majority were male, with 38 (48.7%) and 71 (53.0%), and the mean ages were 39.4±10.5 years and 39.7±10.2 years in the TLD and TENO-EM+RPV groups, respectively. The mean initial eGFR was 105.1±15.4 mL/min/1.73 m² in the TLD group and 102.6±15.5 mL/min/1.73 m² in the TENO-EM+RPV group. The mean changes in eGFR after switching from TEEVIR to TLD at 12, 24, and 48 weeks decreased by 15.7, 15.1, and 19.3 mL/min/1.73 m², respectively. The decreases in the group that switched to TENO-EM+RPV were 8.9, 7.6, and 11.9 mL/min/1.73 m², respectively. When comparing the mean changes in eGFR between the two groups at 12, 24, and 48 weeks, there were statistically significant differences of 6.8, 7.5, and 7.4 mL/min/1.73 m², respectively.
CONCLUSIONS: HIV-infected patients who switched to either TLD or TENO-EM+RPV experienced a decrease in mean eGFR with both regimens. The TLD regimen resulted in a statistically significantly greater mean eGFR decrease than TENO-EM+RPV.
Thaiclinicaltrials.org number, TCTR202410300006
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