Renal Outcomes Over the Course of 5 Years of Oral HIV Preexposure Prophylaxis Using Tenofovir Disoproxil/Emtricitabine

Renal Outcomes Over the Course of 5 Years of Oral HIV Preexposure Prophylaxis Using Tenofovir Disoproxil/Emtricitabine

Introduction: Tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) is used as oral preexposure prophylaxis (PrEP) to prevent HIV. Because TDF could be nephrotoxic, we assessed the association between PrEP use and kidney function over time. Methods: We included men who have sex with men (MSM) from t...

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Main Authors: Dita C. Bolluyt, Mark A.M. van den Elshout, Eline S. Wijstma, Anders Boyd, Elske Hoornenborg, Henry J.C. De Vries, Maria Prins, Liffert Vogt, Maarten F. Schim van der Loeff, T. van Benthem, D. Bons, G.J. de Bree, P. Brokx, U. Davidovich, S. Hendriks, S.E. Geerlings, M. Heidenrijk, E. Hoornenborg, J. Heijne, P. Reiss, A. van Sighem, M. van der Valk, J. de Wit, P. Zantkuijl, N. Schat, L. Dol, M. van Agtmael, J. Ananworanich, D. Van de Beek, G.E.L. van den Berk, D. Bezemer, A. van Bijnen, J.P. Bil, W.L. Blok, S. Bogers, M. Bomers, A. Boyd, W. Brokking, D. Burger, K. Brinkman, N. Brinkman, M. de Bruin, S. Bruisten, L. Coyer, R. van Crevel, M. Dijkstra, Y.T. van Duijnhoven, A. van Eeden, L. Elsenburg, M.A.M. van den Elshout, E. Ersan, P.E.V. Felipa, T.B.H. Geijtenbeek, J. van Gool, A. Goorhuis, M. Groot, C.A. Hankins, A. Heijnen, M.M.J. Hillebregt, M. Hommenga, J.W. Hovius, Y. Janssen, K. de Jong, V. Jongen, N.A. Kootstra, R.A. Koup, F.P. Kroon, T.J.W. van de Laar, F. Lauw, M.M. van Leeuwen, K. Lettinga, I. Linde, D.S.E. Loomans, I.M. van der Lubben, J.T. van der Meer, T. Mouhebati, B.J. Mulder, J. Mulder, F.J. Nellen, A. Nijsters, H. Nobel, E.L.M. Op de Coul, E. Peters, I.S. Peters, T. van der Poll, O. Ratmann, C. Rokx, M.F. Schim van der Loeff, W.E.M. Schoute, J. Schouten, J. Veenstra, A. Verbon, F. Verdult, J. de Vocht, H.J. de Vries, S. Vrouenraets, M. van Vugt, W.J. Wiersinga, F.W. Wit, L.R. Woittiez, S. Zaheri, Żakowicz, M.C. van Zelm, H.M.L. Zimmermann
Format: Article
Language:English
Published: Elsevier 2025-06-01
Series:Kidney International Reports
Subjects:
eGFR
HIV
kidney function
men who have sex with men
preexposure prophylaxis
Online Access:http://www.sciencedirect.com/science/article/pii/S2468024925001767
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Summary:Introduction: Tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) is used as oral preexposure prophylaxis (PrEP) to prevent HIV. Because TDF could be nephrotoxic, we assessed the association between PrEP use and kidney function over time. Methods: We included men who have sex with men (MSM) from the Amsterdam PrEP demonstration Project (AMPrEP; 2015–2020) at the Public Health Service of Amsterdam, who had an estimated glomerular filtration rate (eGFR) ≥ 60 ml/min per 1.73 m2 and ≥ 1 creatinine measurement after baseline. Participants could choose between daily or event-driven PrEP use. Plasma creatinine was measured at PrEP commencement and annually thereafter. Kidney function was calculated as the eGFR using the 2021 Chronic Kidney Disease-Epidemiology Collaboration formula. Results: Among the 351 participants analyzed (median age: 41 years, interquartile range [IQR] = 33–49), mean eGFR at PrEP commencement was 100 ml/min per 1.73 m2 (SD = 14). During a median follow-up of 54.2 months (IQR = 47.0–57.6), eGFR decreased by 0.30/yr (95% confidence interval [CI] = − 0.59 to − 0.01). We observed lower mean eGFR decline in those using daily PrEP than in those using event-driven PrEP (− 3.05, 95% CI = − 3.95 to − 2.15), and in older participants (− 5.75/10 yrs, 95% CI = − 6.70 to − 4.80). Daily PrEP users had an average decline in eGFR of 0.57 ml/min per 1.73 m2/yr (95% CI = − 1.06 to − 0.08), and there was no statistically significant decline in event-driven PrEP users (P for interaction = 0.30). Twelve participants (3.4%) had an incident eGFR < 60 during follow-up, none of which persisted. Conclusion: Daily PrEP users had a faster decline over time than event-driven PrEP users, yet eGFR declines were low and within the range of those expected in the general population. Our data support reduced kidney function monitoring in PrEP users at low risk for kidney dysfunction.
ISSN:2468-0249

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