There is life with HIV

Tenofovir DF to TAF improves bone and renal safety

Replacement of Tenofovir DF for TAF improves bone and kidney health

S Substitution of Tenofovir DF for TAF suffers a lot from, say…. AF * da do Dente ”: It is known by the entire scientific community that the switch from tenofovir DF to TAF is much better for kidney and bone health. They are, without wanting to insult the worms club, a large flock of worms

Tenofovir DF replacement for TAF is scientifically proven to improve quality of life by decreasing bone loss and complications with the kidneys

 

Swap Tenofovir DF for TAF: Published: February 26, 2018

 

People with HIV who bind the old tenofovir disoproxil fumarate ™ (TDF) formulation of tenofovir ™ alafenamide ™ (TAF) were more efficient in maintaining viral load suppression and showed improvements in both bone density and kidney function, based on their biomarkers, according to studies presented in the 2016 ASM Microbe conference last month in Boston.

Gilead Sciences ”holder of the tenofovir disoproxil fumarate ™ brand (brand name Viread ™ and a component of  Complera Atripla and Truvada co-formulations and Stribild ) is one of the most widely used antiretroviral drugs in antiretroviral therapies (ART) and has been generally considered safe and well tolerated, but it can cause bone loss soon after treatment begins and lead to kidney problems in sensitive individuals.

Switching from Tenofovir DF to TAF: The active agent tenofovir diphosphate, is "delivered" more efficiently to cells and this is a type of "plus" that cannot be ignored. 

I have read, not sure what would have been the reliable source that has given me this context, and since then I wonder about the whys of time dilation with regard to shifting from the better to the worse. I did not need to think much, but I did not remember which text it was in, and because I have tried to use a more personal and human posture (Yes E. Mandetta, you are right, the people who see here also need a lap! I wanted yours so much, in that promise ...).

Well, what keeps them from acting decently is this:


TAF ™
 is a new prodrug ™, which provides the active agent tenofovir diphosphate more efficiently to cells. It produces adequate levels of intracellular drug at a much lower dose, which means less concentration in blood plasma and less exposure to the drug in our bones, kidneys and other organs and tissues. TAF is a component of the  Odefsey Genvoya,, and co-formulations,Descovy  recently approved for use in the European Union and the USA.

Edwin De Jesus of the Orlando Immunology Center and colleagues presented a poster describing the 96-week results of the Gilead study GS-US-292-0109, a phase 3 study, in which people with viral suppression on a regimen containing TDF either have if listed in the same treatment or linked to a regimen containing TAF.

Exchange from Tenofovir DF to TAF: a study with almost 1500 people

The study included 1436 people with HIV who had an undetectable viral load (<50 copies / ml) at baseline. About 90% were men, two thirds were white, about 19% were black (a group at higher risk for kidney disease), the median age was around 41 years and the average CD4 cell count was approximately 670 cells / mm3. They had to have renal function close to normal, at baseline, with an estimated glomerular filtration rate (eGFR) above 50 ml / min; the average rate was about 106 ml / min

Participants were taking Atripla

At the time of entry into the study, participants were taking Atripla (efavirenz / TDF / emtricitabine) Stribild(Elvitegravir / cobicistat / TDF / emtricitabine), driven by Atazanavir /Reyataz () plus  Truvada(TDF / emtricitabine). They were randomly assigned (2: 1) to stay on that therapeutic schedule or switch to Genvoya (elvitegravir / cobicistat / TDF / emtricitabine).

The International AIDS Society Conference last summer reported in a survey that, in 48 weeks, participants who linked to TDF-containing schemes for Genvoya were significantly better able to maintain virological suppression and had significant improvements in spine and hip bone mineral density (BMD) and markers of renal function.

Switching from Tenofovir DF to TAF: Dr De Jesus reported that at 96 weeks, both regimens remained highly effective, but Genvoya had a statistically significant edge of advantagea

Dr De Jesus reported that, at 96 weeks, both schemes remained highly effective, but Genvoya it had a statistically significant advantage edge: 93% of people who switched to the TAF scheme had undetectable viral loads compared to 89% of those who stayed on their TDF scheme; the results were similar regardless of the regime they were on and switched to the TDF scheme. Only 2% of participants in both groups had therapeutic failure, but people in the TDF arm were more likely to miss the exam collections that would collect viral load data (5% vs 9%).

A supportive Editor's Note:

 This is a very relevant fact and may be the balance of the scale that would explain why this “significant improvement and, in my opinion, in such an important study, even the collection of this material would have to be done anyway, even if the home, because we are not, now, able to imagine the reasons (yes, in the plural) for the research subject to be absent from something so important, a study protocol) where he himself would be misinterpreted - by way of explo, and bad For example, I missed my last CD4 and CV count. MAs had 1160 CD4 and my viral load has remained undetectable for almost ten years)… End of the editor's note.

Tenofovir DF for TAF: regimens were generally safe and well tolerated

All regimes were generally safe and well tolerated, but again Genvoya had an advantage: 0,9% in users of the TAF therapy group who had stopped treatment due to adverse events compared to 2,5% in the TDF group.

Bone density of the spine increased by 2,0% in TAF switches and decreased by -0,3% in the group that followed on continuing therapy with TDF; hip bone density increased by 2,1% and fell by -0,6%, respectively.

Switching from Tenofovir DF to TAF: In 96 weeks (less than dis years), people who switched from tenofovir DF to TAF saw significant reductions in osteoporosis (brittle bones) 

At 96 weeks, people who switched from tenofovir DF to TAF saw significant reductions in osteoporosis (brittle bones) or osteopenia (less severe decrease in bone density).

People who switched from tenofovir DF to TAF experienced significant improvements in renal function markers (serum creatinine, phosphate and excretion of uric acid, albumin and proteins in the urine), while those who remained on TDF regimens worsened.

There were two adverse events related to renal functions, leading to disruption in the TAF group (acute kidney injury and interstitial nephritis tubule) and five in the TDF group (chronic kidney disease, Fanconi syndrome, renal colic and two cases of elevated creatinine levels in the blood).

Tenofovir DF for TAF associated with worst blood lipid results

 

However, the TAF group had the worst blood lipid results. Tenofovir is known to reduce lipid levels and the lower concentration of TAF had a lesser effect than those that remained on the TDF regimen.

Fasting lipid levels were higher in the TAF group than in the TDF group and 8% vs 5% started lipid-lowering drugs.

“Patients who switched to [Genvoya] from a TDF-based scheme were significantly more likely to maintain success in virological suppression ”and“ had significant improvements in the BMD spine and hip; had significant reductions in osteopenia and osteoporosis, and showed significant improvement in proteinuria and other markers of kidney function, ”the researchers concluded.

Switching from Tenofovir DF to TAF: data suggest that switching from TDF to TAF may be associated with reduced risk of osteoporosis and fracture, as well as long-term fragility ...

A study by E. Turner Overton at the University of Alabama at Birmingham and colleagues looked like go into more detail in bone loss among people on tenofovir therapy. Its poster presents an analysis of changes in bone mineral density, parathyroid hormone (PTH, a hormone that regulates calcium and phosphate metabolism) and serum levels of bone turnover markers (P1NP and CTx) over week 48 in people who changed from containing schemes from TDF to Genvoya in the same study.

In addition to the previously reported gains in bone density spine and hip, mean PTH levels decreased after Genvoya, while levels in the TDF group decreased. The biomarkers of bone turnover decreased significantly in the group in which there was an interruption.

"These data suggest that switching from TDF to TAF can be associated with reduced risk of osteoporosis and fracture, as well as long-term frailty," concluded the researchers - an important consideration in groups like people with HIV who are going to live more and require a greater amount of ART throughout life.

Tenofovir DF para TAFFinally, Gregório Huhn from the Chicago branch and colleagues analyzed renal outcomes among people considered to be at high risk for chronic kidney disease (CKD) who switched from TDF to TAF in the same trial. Most doctors advise that people with poor kidney function should not use TDF and current TDF and prescribe instructions that include dose reductions for people with pre-existing kidney failure. 

And it would be appropriate to infer that it may be safer for people with kidney dysfunction to use the formulation with TAF.

Huhn's team, classifying participants into two groups according to high or low risk for Chronic Kidney Disease (CKD). The high-risk group had two or more predisposing factors including female gender, black race, 50 years of age or older, a CD4 count <200 cells / mm³, abnormal blood lipids, high blood pressure, diabetes, use of NSAIDs ( non-steroidal anti-inflammatory drugs), and clinical or subclinical renal failure from adverse events at baseline; low-risk group had zero or one factor. A total of 323 people who switched TAF and 168 who remained on TDF schemes were considered to be at high risk.

Outcomes of interest included incident or new cases of Chronic Kidney Disease, defined as eGFR <60 ml / min among people who started with > 60; abandoning the use of the drug due to adverse events related to the kidneys; and changes in urine renal protein biomarkers including and albumin, and retinol binding to protein and creatinine as well as macroglobulin-beta-2- for creatinine ratios.

CKD incident developed in 2% of TAF switches and 3% of patients who continued with the TDF formulation considered high risk - it was not a significant difference. Among people considered to be at low risk for CKD, 1% of TAF switches and 2% who stayed at TDF developed CKD, which has reached statistical significance. In the high risk category, two TAF switches and two TDF users discontinue the use of these co-formulations due to adverse events related to renal failure, as did three low-risk but not low-risk TAF Allegiant users (translator note: In all the “translation I know of on the Internet features none gave me anything other than Allegiant to translate Allegiant - I will remain in the search, but for now, impossible). A single high-risk patient who remained in the TDF study developed Fanconi syndrome.

Tenofovir DF for TAF: Data suggest that switching from TDF to TAF may be associated with reduced risk of osteoporosis and fracture, as well as long-term frailty.

Urine protein and albumin decreased in the study arm that discontinued TAF therapy, while increasing the number of participants who switched to TDF therapy across all risk categories for CKD. However, only high-risk participants experienced a substantial change - a 33% increase. Falls in tubular proteinuria between switches for TAF and increases among users who continued therapy with TDF were seen in groups of high, medium and low risk of CKD.

Based on these findings, the researchers summarized: People at high risk for kidney disease who switched to Genvoya “With low incidence of CKD,” had no abandonment due to tubulopathic renal failure*, and saw significant reductions in proteinuria and tubular proteinuria.

Tenofovir DF to TAF:

“These results demonstrate the lasting effectiveness and better safety of kidney Genvoya [] as a switch scheme for adults with an underlying risk for CKD, ”he concluded.

Editor's note: for not being part of the text, I put, below, the definition of what comes to be theretubolopática renal nsuficiência: is the sudden loss of the ability of your kidneys to filter out waste, salts and blood fluids. When this happens, the waste can reach dangerous levels and affect the chemical makeup of your blood, which can get out of balance.

Also called acute kidney injury, failure is common in patients who are already in the hospital with some other condition. You can develop rapidly over a few hours or more slowly over several days. People who are seriously ill and require intensive care are at increased risk of developing acute renal failure.

Acute renal failure can be fatal and requires intensive treatment. However, it may be reversible. It depends on the state of health of the patient.... read more (opens in another tab, in a site in Portuguese)

Liz Highleyman

Produced in a collaboration between the Aidsmap  and the Hivandhepatitis.com

Translated by Claudio Souza from the original in English on the link Switching to new tenofovir alafenamide keeps virus in check and Improves kidney and bone health

Reviewed by Mara Macedo

Originally published on: July 11, 2011 and July 18, 2016

Soropositivo.Org since August 1, 2000 in the fight against discrimination, AIDS, Prejudice. There is life with HIV!


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