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Abstract: PO2022

The Effect on Renal Function of Patients on HIV Pre-Exposure Prophylaxis (PrEP)

Session Information

Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

  • 1800 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)

Authors

  • Tiu, Alfredo B., VA San Diego Healthcare System, San Diego, California, United States
  • Looney, David J., VA San Diego Healthcare System, San Diego, California, United States
Background

Tenofovir, a nucleotide reverse transcriptase inhibitor, is used in management of hepatitis B and as part of a highly active antiretroviral medication regiments for HIV infected individuals. Tenofovir disoproxil fumarate (TDF) is one of two tenofovir nucleotide analog. The U.S. Food and Drug Administration (FDA) recommended on 16 July 2012 the use of tenofovir-emtricitabine combination medication as pre-exposure prophylaxis (PrEP) against HIV. TDF is cleared through glomerular filtration and tubular secretion. Its nephrotoxicity includes renal tubular acidosis type 2, acute tubular necrosis, and tubulointerstitial disease. Reported data regarding effect of renal function from tenofovir based PrEP are less than 24 months of follow-up. This study evaluates the effect on renal function in patients receiving TDF for PrEP over more than 24 months because it can affect the future of PrEP with more expensive analog of tenofovir (TAF) promoted as less nephrotoxic and other PrEP medications.

Methods

VA San Diego database on adults receiving PrEP is the source for this data. Serum creatinine and estimated glomerular filtration rate (eGFR) are obtained as part of PrEP protocol which started in 2014. The PrEP protocol follows the Centers for Disease Control and Prevention (CDC) recommendations of pre-initiation serum creatinine and eGFR then 3 months after the initiation and annually thereafter. Acute kidney injury is define as an increase in serum creatinine by > 0.3mg/DL within 48 hours or increase in serum creatinine to > 1.5 times baseline based on the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines which is the most recent preferred definition and used more consistently in clinical studies (1,2).

Results

Since 2014, 103 individuals are in the PrEP program. At one year, there are 87 individuals and none meets the criteria for AKI. After 2 years, there are 73 patients and 2 meet the criteria of AKI. Their kidney function returned back to baseline creatinine one month later. 55 individuals completed 3 years on PrEP and none meets the criteria for AKI. 41 individuals completed 4 years of PrEP and none meets criteria for AKI. The average change of eGFR at one year is 7.1%, 7.5% at 2 years, 8.6% at 3 years and 8.1% at 4 years.

Conclusion

Serum creatinine is stable on PrEP and none meet KDIGO AKI definition. The decrease in eGFR is not significant to warrant a change of TDF based PrEP.