Tenofovir Alafenamide as Part of a Salvage Regimen in a Patient with Multi-Drug Resistant HIV and Tenofovir-DF-Associated Renal Tubulopathy

Abstract

Brief Summary We describe a patient with two recent episodes of tenofovir disoproxil fumarate (TDF)-associated acute kidney injury and six-class drug-resistant HIV infection who achieved and maintained viral suppression without worsening kidney function on a regimen including tenofovir alafenamide (TAF) through 48 weeks of therapy. The safety and efficacy of TAF in patients with TDF-associated renal tubulopathy and multiple drug resistance HIV has not yet been described. TAF may represent a useful option to maximally suppress HIV in patients with these complications.

Renal function change after switching tenofovir disoproxil fumarate for tenofovir alafenamide in the HIV-positive patients of a metropolitan sexual health service

“…Available evidence for patients with significant renal impairment, but without significant comorbidities, is presently limited to case reports. These suggest though that the switch to TAF is capable of ameliorating significant TDF-induced renal dysfunction [17, 18], even to the point of reversing Fanconi syndrome [19].…”

Early safety of tenofovir alafenamide in patients with a history of tubulopathy on tenofovir disoproxil fumarate: a randomized controlled clinical trial

“…While these data suggest that there were no immediate demonstrable adverse effects of TAF on kidney function, longer term safety data are required to confirm the safety of TAF in this vulnerable group of patients, and hence this study will continue to follow all participants until at least 96 weeks. Clinical trial data suggest that TAF may be a suitable option for people with HIV infection who have mild-tomoderate CKD, [11] and, while some case reports suggest that TAF may also be an option for those who experienced treatment-limiting PRT on TDF, [12][13][14][15] others have reported acute kidney injury (AKI) with and without tubular function abnormalities in selected individuals receiving TAF [19][20][21][22]. While these cases raise the possibility of TAF nephrotoxicity, in one case the patient took an overdose (300 mg of TAF among other compounds); the second patient had liver cirrhosis and diabetes, actively used heroin and cocaine, had multiple co-medications and presented with AKI and nephrotic syndrome; the third patient had decompensated liver cirrhosis, actively used alcohol, underwent treatment for hepatitis and also presented with AKI and nephrotic syndrome; and the fourth patient presented with AKI shortly after switching from TDF, which he had tolerated for the past 10 years, each suggesting that other factors could have contributed to and/or were responsible for the kidney injury.…”

“…Individuals who developed PRT while receiving TDF, however, may be uniquely susceptible to the adverse effects of tenofovir on the kidneys and bone. While TAF has been used in a small number of individuals who developed PRT on TDF , it remains to be confirmed whether TAF can be used safely in this group of patients.…”

Short Communication: Resolution of Tenofovir Disoproxil Fumarate Induced Fanconi Syndrome with Switch to Tenofovir Alafenamide Fumarate in a HIV-1 and Hepatitis B Coinfected Patient

“…9 This study, our experience, and previously reported case reports of TAF use in the setting of Fanconi syndrome suggests that TAF may have a particularly beneficial role in persons with TDF-induced renal tubular disease. 10,11 However, one limitation in the translatability of this patient's experience is that he had access to FTC/TAF dosed at 200/10 mg due to concurrent dosing with r/DRV. Whether the FDA-approved dosage of FTC/TAF at 200/ 25 mg provides similar benefit to persons with tubular nephropathy when combined with a boosted protease inhibitor remains unknown.…”