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Recovery of Tenofovir-induced Nephrotoxicity following Switch from Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide in Human Immunodeficiency Virus-Positive Patients

Infection & Chemotherapy 2020년 52권 3호 p.381 ~ 388
서준원, 김기천, 전강일, 강창경, 문송미, 송경호, 방지환, 김의석, 김홍빈, 박상원, 김남중, 최평균, 박완범, 오명돈,
소속 상세정보
서준원 ( Seo Jun-Won ) - Seoul National University College of Medicine Department of Internal Medicine
김기천 ( Kim Ki-Chun ) - Seoul National University College of Medicine Department of Internal Medicine
전강일 ( Jun Kang-Il ) - Seoul National University College of Medicine Department of Internal Medicine
강창경 ( Kang Chang-Kyung ) - Seoul National University College of Medicine Department of Internal Medicine
문송미 ( Moon Song-Mi ) - Seoul National University College of Medicine Department of Internal Medicine
송경호 ( Song Kyoung-Ho ) - Seoul National University College of Medicine Department of Internal Medicine
방지환 ( Bang Ji-Hwan ) - Seoul National University College of Medicine Department of Internal Medicine
김의석 ( Kim Eu-Suk ) - Seoul National University College of Medicine Department of Internal Medicine
김홍빈 ( Kim Hong-Bin ) - Seoul National University College of Medicine Department of Internal Medicine
박상원 ( Park Sang-Won ) - Seoul National University College of Medicine Department of Internal Medicine
김남중 ( Kim Nam-Joong ) - Seoul National University College of Medicine Department of Internal Medicine
최평균 ( Choe Pyoeng-Gyun ) - Seoul National University College of Medicine Department of Internal Medicine
박완범 ( Park Wan-Beom ) - Seoul National University College of Medicine Department of Internal Medicine
오명돈 ( Oh Myoung-Don ) - Seoul National University College of Medicine Department of Internal Medicine

Abstract


Background: Tenofovir disoproxil fumarate (TDF)-induced nephrotoxicity is related to high plasma tenofovir concentrations. Tenofovir alafenamide (TAF) is a tenofovir prodrug with 90% lower plasma tenofovir concentrations. The aim of this study was to evaluate changes in tenofovir-induced nephrotoxicity in Human Immunodeficiency Virus (HIV)-positive patients who switched from TDF to TAF.

Materials and Methods: We identified all HIV-positive patients who switched from elvitegravir/cobicistat/emtricitabine/TDF to elvitegravir/cobicistat/emtricitabine/TAF at a tertiary hospital. We assessed tubulopathy and renal dysfunction before TDF administration, at the time TAF was used following at least 3 months of TDF use, and 3 months after TAF administration. Tubulopathy was defined by the presence of at least three abnormalities in fractional excretion of phosphate, fractional excretion of uric acid, urinary β2-microglobulin, urinary N-acetyl-β-D-glucosaminidase, glucosuria or proteinuria. Renal dysfunction was defined as decreased by more than 25% in the estimated glomerular filtration rate (eGFR) relative to baseline.

Results: In 80 patients, the mean eGFR was 96.8 mL/min/1.73 m2 before administration of TDF, 81.2 (P <0.001) at the time of change to TAF, 90.9 (P <0.001) after TAF administration. Renal dysfunction occurred in 19 patients (23.8%) after TDF use for a median 15 months, 11 (57.9%) of these patients recovered from renal dysfunction after TAF administration. Six patients (7.5%) had tubulopathy before TDF administration, 36 (45.0%) after TDF administration (P <0.001), 12 (15.0%) after TAF administration (P = 0.002).

Conclusion: Tenofovir-induced nephrotoxicity in HIV-positive patients receiving TDF was mostly reversible after changing to TAF. Thus, TAF-containing regimens can be administered safely to HIV-positive patients with tenofovir-induced nephrotoxicity.

키워드

Renal dysfunction; Tubulopathy; Tenofovir disoproxil fumarate; Tenofovir alafenamide; HIV

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