Hispanic/Latinx and Black adults initiating tenofovir alafenamide (TAF) or switching from tenofovir disoproxil Fumarate (TDF) to TAF confirmed considerably improved bone and renal parameters in contrast with sufferers taking TDF1, based on analysis introduced at IDWeek 2019, held October 2 to October 6, in Washington, DC. Analysis from one other session reported that sufferers switching from triple antiretroviral remedy (ART) containing TDF to a 2-drug routine of dolutegravir (DTG) and rilpivirine (RPV) was related to sustained enchancment in bone mineral density.2
The primary examine analyzed pooled knowledge on Hispanic/Latinx and Black contributors from 7 randomized medical trials (2 treatment-naïve, 5 suppressed swap) to evaluate the security and efficacy of TAF-based regimens in contrast with TDF-based regimens for ART initiation or switching inside these populations, that are sometimes underrepresented in medical trials. Virologic suppression (HIV-1 RNA <50 copies/mL) and share change in bone mineral density had been assessed, as had been the renal tubular biomarker ratios of urine beta-2-microglobulin to creatinine and retinol binding protein tocreatinine.
Among the many complete pooled inhabitants of the 7 research (N=5825), 1138 contributors had been Hispanic/Latinx and 1324 had been Black. The median age amongst remedy naïve contributors was 34 years, median HIV-1 RNA was four.6 log copies/mL, and CD4 rely was 405 cells/mm. Amongst swap contributors (n=4092), median age was 45 years, and CD4 was 653 cells/mm. There was no between-group distinction in virologic suppression charge. In each naive and swap contributors, TAF and TDF confirmed well-maintained virologic suppression charges and each had been well-tolerated. At week 96, fewer results on renal biomarkers was seen in all teams initiating TAF (P <.001); bone mineral density decreases had been additionally smaller (P <.005) in contrast with TDF. All teams that switched from TDF to TAF confirmed tubular proteinuria decreases and bone mineral density enhancements (P <.001 for each).
Investigators concluded, “These knowledge in >2400 Hispanic/Latinx and Black [people living with HIV] display noninferior efficacy and security benefits with TAF vs TDF.”1
Kahl and colleagues2 additionally highlighted ART regimens with favorable results on bone density. Researchers reported on a substudy of the SWORD trials, which in contrast the consequences of adjusting ART brokers. The trials randomly assigned adults with HIV-1 RNA <50 copies/mL who acquired ART containing TDF for ≥ 6 months prior to review initiation to both obtain DTG+RPV (early swap group) on day 1, or to proceed present triple-therapy by way of week 48 at which period sufferers with viral suppression had been switched to DTG+RPV (late swap). Bone mineral density for hip and lumbar backbone had been measured by centrally-read dual-energy X-ray absorptiometry (DEXA) scans for the first finish level, and secondary finish factors included bone mineral density change and bone turnover markers by way of week 148.
Important will increase for complete hip bone mineral density had been noticed amongst contributors in each teams following the swap to DTG+RPV by way of 100 weeks, with a nonsignificant improve seen in contributors within the early swap group at week 148. At 48 weeks post-switch, lumbar bone mineral density considerably elevated from baseline and remained elevated, although not considerably, from baseline by way of week 148. Bone mineral density was related amongst contributors in each teams by way of 100 weeks. By week 148, a minimal improve in bone mineral density and a major lower in bone turnover markers had been seen (P <.001 to zero.042 throughout all markers) from baseline amongst lengthy swap contributors.
Examine investigators concluded, “Change to the DTG+RPV [2-drug regimen] was related to sustained enhancements in [bone mineral density] by way of [week] 148, together with discount in bone markers. The favorable results on skeletal well being had been noticed regardless of the getting older of examine sufferers and different components lowering bone mineral density.”
Because the inhabitants of individuals residing with HIV ages, growing remedy regimens that account and compensate for potential age-related comorbidities comparable to osteoporosis and kidney illness is a necessity, and is an space that will drastically profit from additional examine.
Disclosure: A number of examine authors declared affiliations with the pharmaceutical trade. Please see the unique reference for a full checklist of authors’ disclosures.
1. DeJesus E, Villanueva JFA, Lopez JRA, et al. Tenofovir alafenamide (TAF) versus tenofovir disoproxil fumarate (TDF) in hispanic/latinx and black contributors: Efficacy, bone and renal security outcomes from a pooled evaluation of seven medical trials. Poster introduced at: IDWeek 2019; October 2-6, 2019; Washington, DC. Poster 318.
2. Kahl L, McComsey GA, Poggio MC, et al. Change from TDF containing routine to DTG+RPV maintains bone mineral density and reduces bone turnover markers over 148 weeks. Poster introduced at: IDWeek 2019; October 2-6, 2019; Washington, DC. Poster 319.