Lamivudine or emtricitabine (XTC)/protease inhibitor dual therapy as a harm-reduction strategy in patients with tenofovir-related renal toxicity: A case-control study

• Published in: Scandinavian journal of infectious diseases 2012-11, Vol.44 (11), p.879-883
• Main Authors: Rossotti, Roberto, Moioli, Maria Cristina, Chianura, Leonardo, Errante, Isabella, Orcese, Carloandrea, Orso, Maurizio, Schiantarelli, Clara, Schlacht, Irene, Travi, Giovanna, Vigo, Beniamino, Villa, Maria Riccarda, Volonterio, Alberto, Puoti, Massimo
• Format: Article
• Language: English
• Subjects: Adenine - adverse effects; Adenine - analogs & derivatives; Adult; Aged; Case-Control Studies; CD4 Lymphocyte Count; Chi-Square Distribution; Deoxycytidine - analogs & derivatives; Deoxycytidine - therapeutic use; Drug Therapy, Combination; dual therapy; Emtricitabine; Female; HIV; HIV Infections - drug therapy; HIV Infections - immunology; Humans; kidney damage; Kidney Diseases - chemically induced; Kidney Diseases - immunology; Kidney Diseases - virology; Kidney Function Tests; Lamivudine - therapeutic use; Male; Middle Aged; Organophosphonates - adverse effects; Protease Inhibitors - therapeutic use; Retrospective Studies; Reverse Transcriptase Inhibitors - adverse effects; Reverse Transcriptase Inhibitors - therapeutic use; Tenofovir; Viral Load
• ISSN: 0036-5548; 1651-1980
• DOI: 10.3109/00365548.2012.693195

Tenofovir disoproxil fumarate (TDF) is widely used in HIV-infected patients. It is associated with tubular toxicity, but its management is controversial. A possible strategy is to switch to a dual therapy based on lamivudine or emtricitabine (XTC) and protease inhibitors (PIs). A case-control study was designed to evaluate the switch to XTC + PI therapy in patients with TDF-related renal toxicity. A case was defined as a patient who was on TDF/XTC + PI and who switched to XTC + PI. A control was defined as a patient with the same clinical features who remained on TDF/XTC + PI. Twenty-one cases and 21 controls were included. After 48 weeks, no differences in efficacy were observed. No improvement in the glomerular filtration rate as estimated with the Cockroft-Gault formula (eGFR) was seen, but the number of times that patients had values below 60 ml/min was higher with standard TDF/XTC 1 PI treatment than with dual XTC + PI treatment. A switch to dual therapy could be an option for patients at risk of TDF-related renal damage with no relevant risk of virological or immunological failure.