Rates and predictors of switching to tenofovir alafenamide-containing ART in a nationwide cohort

• Published in: BMC infectious diseases Vol. 19; no. 1; pp. 1 - 9
• Main Authors: Surial, Bernard, Cavassini, Matthias, Calmy, Alexandra, Fehr, Jan, Stöckle, Marcel, Bernasconi, Enos, Roth, Bianca, Fux, Christoph A, Kovari, Helen, Furrer, Hansjakob, Rauch, Andri, Wandeler, Gilles, Anagnostopoulos, A, Battegay, M, Bernasconi, E, Böni, J, Braun, D.L, Bucher, H.C, Calmy, A, Cavassini, M, Ciuffi, A, Dollenmaier, G, Egger, M, Elzi, L, Fehr, J, Fellay, J, Furrer, H, Fux, C. A, Günthard, H.F, Haerry, D, Hasse, B, Hirsch, H.H, Hoffmann, M, Hösli, I, Huber, M, Kahlert, C.R, Kaiser, L, Keiser, O, Klimkait, T, Kouyos, R.D, Kovari, H, Ledergerber, B, Martinetti, G, Martinez de Tejada, B, Marzolini, C, Metzner, K.J, Müller, N, Nicca, D, Paioni, P, Pantaleo, G, Perreau, M, Rauch, A, Rudin, C, Scherrer, A.U, Schmid, P, Speck, R, Stöckle, M, Tarr, P, Trkola, A, Vernazza, P, Wandeler, G, Weber, R, Yerly, S
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 10.10.2019; BioMed Central; BMC
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Biomedical materials; Bone density; Cardiovascular disease; CD4 antigen; Chronic infection; Confidence intervals; Darunavir; Diabetes; DNA polymerases; Dosage and administration; Drug therapy; Drug toxicity; Emtricitabine; Fractures; Grants; Heart attacks; Hepatitis; Hepatitis C; Highly active antiretroviral therapy; HIV; HIV patients; Human immunodeficiency virus; Infections; Laboratories; Non-nucleoside reverse transcriptase inhibitors; Nucleosides; Osteoporosis; Patient outcomes; Proteinuria; Raltegravir; Renal function; Risk analysis; Risk factors; RNA-directed DNA polymerase; Sex ratio; Sexually transmitted diseases; Statistical analysis; STD; Switch; Switches; Switching; Tenofovir; Tenofovir alafenamide; Tenofovir disoproxil fumarate; Therapy; Toxicity; Switzerland; United States > US
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-019-4454-9

Tenofovir alafenamide (TAF)-containing combinations were introduced in Switzerland after October 2016 and are recommended over tenofovir disoproxil fumarate (TDF) in patients with osteoporosis or impaired renal function. We included all participants of the Swiss HIV Cohort Study on TDF-containing antiretroviral therapy with follow-up visits after January 2016. We determined the proportion of switches from TDF to TAF overall, and among patients with risk factors for TDF toxicity, including osteoporosis, impaired renal function or marked proteinuria. We used multivariable logistic regression to explore predictors of switching from TDF to TAF. We included 5'012 patients, of whom 652 (13.0%) had risk factors for TDF toxicity. A switch from TDF to TAF was undertaken in 2'796 (55.8%) individuals overall, and in 465 (71.3%) with risk factors. Predictors of switching to TAF were male sex (adjusted odds ratio 1.27, 95% confidence interval 1.07-1.50), age > 50 years (1.43, 1.23-1.66) and the presence of risk factors for TDF toxicity (2.21, 1.77-2.75). In contrast, patients with a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based single-pill regimen (0.11, 0.09-0.13), those treated in non-tertiary care centers (0.56, 0.46-0.70), as well as those with CD4 cell counts below 500/[mu]L (0.77, 0.66-0.90) and with chronic hepatitis C infection (0.66, 0.54-0.80) were most likely to stay on TDF. Over 50% of patients on TDF-containing therapy, including the majority of patients at risk for TDF toxicity, were switched to TAF within two years of its introduction in Switzerland. Individuals on NNRTI-based single-pill regimens were most likely to remain on TDF.