Surial, BernardBernardSurialLedergerber, BrunoBrunoLedergerberCalmy, AlexandraAlexandraCalmyCavassini, MatthiasMatthiasCavassiniGünthard, Huldrych FHuldrych FGünthardKovari, HelenHelenKovariStöckle, MarcelMarcelStöckleBernasconi, EnosEnosBernasconiSchmid, PatrickPatrickSchmidFux, Christoph AChristoph AFuxFurrer, HansjakobHansjakobFurrer0000-0002-1375-3146Rauch, AndriAndriRauch0000-0001-5297-6062Wandeler, GillesGillesWandeler2024-09-202024-09-202020-07-23https://boris-portal.unibe.ch/handle/20.500.12422/44881BACKGROUND Replacing tenofovir disoproxil fumarate (TDF) with tenofovir alafenamide (TAF) improves renal tubular markers in HIV-infected individuals, but the impact on estimated glomerular filtration rate (eGFR) remains unclear. METHODS We included all participants from the Swiss HIV Cohort Study who switched from a TDF to a TAF-containing antiretroviral regimen or continued TDF. We estimated changes in eGFR and urine protein-to-creatinine ratio (UPCR) after 18 months using mixed-effect models. RESULTS Of 3'520 participants (26.6% women, median age 50 years), 2'404 (68.5%) switched to TAF. Prior to switch, 1'664 (47.3%) had an eGFR <90 mL/min, and 1'087 (30.9%) a UPCR ≥15 mg/mmol. In patients with a baseline eGFR ≥90 mL/min, eGFR decreased with the use of TDF and TAF (-1.7 ml/min). Switching to TAF was associated with increases in eGFR of 1.5 mL/min (95% CI 0.5-2.5) if the baseline eGFR was 60-89 mL/min, and 4.1 mL/min (95% CI 1.6-6.6) if <60 mL/min. In contrast, eGFR decreased by 5.8 mL/min (95% CI 2.3-9.3) with the continued use of TDF in individuals with a baseline eGFR <60 mL/min. UPCR decreased after replacing TDF by TAF, independent of baseline eGFR. CONCLUSIONS Switching from TDF to TAF improves eGFR and proteinuria in patients with renal dysfunction.enTenofovir alafenamide antiretroviral therapy comorbidities estimated glomerular filtration rate renal tubulopathy switch urine protein-to-creatinine ratio300 - Social sciences, sociology & anthropology::360 - Social problems & social services600 - Technology::610 - Medicine & healtharticle10.7892/boris.1422373218900310.1093/infdis/jiaa125