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

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 (2019). Rates and predictors of switching to tenofovir alafenamide-containing ART in a nationwide cohort. BMC infectious diseases, 19(1), p. 834. BioMed Central 10.1186/s12879-019-4454-9

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BACKGROUND 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. METHODS 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. RESULTS 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/μL (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. CONCLUSIONS 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Surial, Bernard; Furrer, Hansjakob; Rauch, Andri and Wandeler, Gilles

Subjects:

300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health

ISSN:

1471-2334

Publisher:

BioMed Central

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

24 Oct 2019 14:35

Last Modified:

28 Oct 2019 15:06

Publisher DOI:

10.1186/s12879-019-4454-9

PubMed ID:

31601174

Uncontrolled Keywords:

Antiretroviral therapy Switch Tenofovir alafenamide Tenofovir disoproxil fumarate Toxicity

BORIS DOI:

10.7892/boris.133874

URI:

https://boris.unibe.ch/id/eprint/133874

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