A balance of risks: an audit of lipid and renal outcomes ...A balance of risks: an audit of lipid...

Abalanceofrisks:anauditoflipidandrenaloutcomesinpa5entsprescribedtenofoviralafenamide

Meng-SanWu,DanielaBrawleyGrampianSexualHealth,NHSGrampian

Aberdeen,UnitedKingdom

BackgroundTenofoviralafenamide(TAF)isanalternaHvetotenofovirdisoproxilfumarate(TDF)withapreferablerenalsafetyprofile.HoweversomestudieshaveshownthatTAFcandetrimentallyaffectlipidprofile,contribuHngtoahighercardiovascularrisk.ThelipidandrenaloutcomesofpaHentsprescribedTAF-containingregimensinourservicewereauditedtoassesstheserisksinarealworldseNng.MethodsAllpaHentsprescribedTAF-containingregimensbetween2016and2018wereincludedinthisretrospecHveaudit.DatawasextractedfromNaHonalSexualHealthSystemandTrakcareforbaselinedemographics,lipid-loweringtreatmentandpre/post-TAFlipidandrenalprofile,whichwereassessedagainst theduraHonofTAFexposure.AraHopairedt-testwasusedtocompareoutcomespre/postTAFwhereasnon-linear regressiontoesHmateoverHmechangeinlipidandrenalprofile.ResultsATAF-containingregimenwasprescribedin177paHents;112withcompletedatawereincludedforanalysis.82%weremalewithameanageof51(21-84)years.MedianduraHonofTAFexposurewas59(3-131)weeks.Totalcholesterol(TC),LDL-cholesterolandtriglyceridesincreasedpostTAFin67.0%,58.0%and59.8%ofpaHentsrespecHvely(Figure1).OverallTC,LDL-cholesterolandtriglycerideswereelevatedby9.3%,9.3%and10.4%;forTCandLDL-cholesterolthiswasmostsignificantinpaHentsswitchingfromTDF(Table1).TCtoHDL-cholesterolraHowasincreasedin47.3%;howeverthechangeinraHowasnon-significant.StaHnswereiniHatedin10.7%ofpaHentspostTAFand11.2%ofthoseswitchingfromTDF(Figure2).CreaHninewasraisedpostTAF,regardlessofpre-TAFanHretroviraltherapystatus.

An5retroviraltherapy Preandpost-TAFra5o p-value Triglyceride(n=112)NaïvetoTAF(n=12)TDFtoTAF(n=89)Non-tenofovirtoTAF(n=11)

1.104(95%CI1.008-1.210)1.285(95%CI1.041-1.585)1.101(95%CI0.9945-1.220)0.9576(95%CI0.6252-1.467)

0.0333*0.0237*0.06350.8254

Totalcholesterol(n=112)NaïvetoTAF(n=12)TDFtoTAF(n=89)Non-tenofovirtoTAF(n=11)

1.093(95%CI1.051-1.137)1.181(95%CI0.9996-1.396)1.105(95%CI1.062-1.151)0.9171(95%CI0.7946-1.059)

<0.0001****0.0504<0.0001****0.2085

LDL-cholesterol(n=112)NaïvetoTAF(n=12)TDFtoTAF(n=89)Non-tenofovirtoTAF(n=11)

1.093(95%CI1.031-1.160)1.182(95%CI0.9668-1.444)1.113(95%CI1.049-1.180)0.7572(95%CI0.4895-1.171)

0.0034**0.09430.0005***0.1621

TotalcholesteroltoHDL-cholesterolra5o(n=112)NaïvetoTAF(n=12)TDFtoTAF(n=89)Non-tenofovirtoTAF(n=11)

0.9887(95%CI0.9537-1.025)0.9923(95%CI0.8933-1.102)1.002(95%CI0.9632-1.043)0.8817(95%CI0.7603-1.022)

0.53170.87450.90510.0873

Crea5nine(n=112)NaïvetoTAF(n=12)TDFtoTAF(n=89)Non-tenofovirtoTAF(n=11)

1.047(95%CI1.019-1.075)1.123(95%CI1.038-1.214)1.028(95%CI0.9988-1.058)1.120(95%CI1.010-1.242)

0.0009***0.0076**0.06000.0352*

ConclusionTAF therapy significantly increased TC and LDL-cholesterol and doubled staHnprescribing.ThisiscoupledwithdeterioraHoninrenaloutcomesregardlessofpre-TAFanHretroviraltherapystatus,againstcommonbeliefinthereno-protecHveroleofTAF,andhighlightstheneedtoconsiderthesefactorspriortocommencingTAF,parHcularlyinpaHentsswitchingfromTDF.AcknowledgementMrsVickyBridgeford,HIVPharmacist,datapull

Table1Preandpost-TAFraHoinlipidandrenaloutcomes Figure1ProporHonsofpaHentswithraisedlipidprofilepostTAF(%)

Figure2StaHnsprescribedinTAF-treatedpaHents

Figure3Post-TAFoverHmechangesinlipidandrenalprofile

No statin pre- or post-TAF (n=88)Statin predates TAF (n=12)Statin postdates (naïve to TAF) (n=1)Statin postdates TAF (TDF to TAF) (n=10)Statin postdates TAF (non-tenofovir to TAF) (n=1)

*LDL-cholesterollevelbecomesimmeasurablewhentriglyceridelevelabove4.4mmol/L