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Higher cumulative TFV/FTC levels in PrEP associated with decline in renal function
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Reported by Jules Levin
CROI 2016 Feb 22-24 Boston
Monica Gandhi1, David V. Glidden2, Albert Liu1,3, Sybil Hosek4, Mauro Schechter5, Howard Horng6, K. Rivet Amico7, Kenneth Mayer8, Kathleen Mulligan1, and Robert M. Grant1,9 for the iPrEx study team 1Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, U.S.A.; 2Department of Epidemiology and Biostatistics, UCSF; 3Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, U.S.A.; 4Department of Psychiatry, Stroger Hospital of Cook County, Chicago, IL, U.S.A.; 5Department of Preventative Medicine, Universidade Federal do Rio de Janeiro, Brazil; 6Department of Bioengineering and Therapeutic Sciences, UCSF; 7School of Public Health, University of Michigan, Ann Arbor, MI, U.S.A.; 8The Fenway Institute and Harvard Medical School, Boston, MA; 9Gladstone Institutes, San Francisco, California, U.S.A.
The decline in eGFR in those with higher exposure (7 days a week) is greater than declines noted in reports from previous studies where "all comers" were taken and we didn't know their level of pill-taking. Take all patients in iPrEx (n=942), the average decrease in creatinine clearance or estimated GFR is 2.5% over 18 months. Taking exposure into account in the subset of those who have hair levels (median follow-up 16.7 months), the decline is greater (6%) if daily dosing is exhibited.
In a separate analysis looking at predictors of having the GFR fall below 70ml/min (which is considered clinically significant- some clinicians stop PrEP in patients who fall below 70ml/min although the CDC guidelines say <60ml/min). In those with daily dosing who were older (>40), there was a significant probability of falling below 70ml/min in a year (if exposure was high). By the way, in the larger sample (n=942), having a starting eGFR of <90ml/min is a major risk factor for subsequently falling below 70 ml/min (the probability of a fall to <70ml/min in those with starting GFRs of <90 over a year is 27%).
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