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

TL;DR

This study found that kidney function declines slightly over 5 years of HIV preexposure prophylaxis, with daily use showing a faster decline than event-driven use, but within normal ranges.

Contribution

The study provides new evidence on the long-term renal effects of daily versus event-driven HIV PrEP use.

Findings

Daily PrEP users had a faster eGFR decline compared to event-driven users, but within general population norms.

Only 3.4% of participants developed an eGFR < 60, and none had persistent decline.

Older participants experienced a greater eGFR decline per year.

Abstract

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.

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.

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.

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.

Figures