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ART Choice with Chronic Kidney Disease

  • 1.  ART Choice with Chronic Kidney Disease

    Posted 03-31-2020 11:51

    What regimen(s) do use in selecting ART for your patients with CKD?
    i have some patients (HLAB5701 negative) on DTG  ABC and renaly adjusted 3TC. Do you still adjust the 3TC dose?  Anyone ever use  TAF in a CKD patient? While Descovy approved down to EGFR 30, Vemlidy for HBV is Approved down to EGFR 15.  Interested to hear your thoughts. I have a dialysis patient on Juluca, but RPV not for everyone. 

    Gary



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    Gary F. Spinner PA,MPH,AAHIVS
    Southwest Community Health Center
    Bridgeport, CT
    gspinner@swchc.org
    Gary.spinner@aya.yale.edu
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  • 2.  RE: ART Choice with Chronic Kidney Disease

    Posted 04-01-2020 08:36
    Hey Gary! 

    I kind of bucket my renal patients into either clearing >30 (or darn close to that) and under. Obviously with around 30 (because they are never going to be exactly 30) I actually dont dose adjust the 3TC. if we start to creep lower than 25, that is when I am more likely to dose adjust the 3TC. In do and have used Biktarvy in patients around the 30 mark (and sometimes again that dynamic and it dips a bit too so I closely monitor) however recently I have been trying to really get away from it if I can and really only using in my hep B co infected or my hep B core + that I cant get to mount antibodies, as we have had a handful of patients reactivate their hep B so now I have full PTSD. 

    for Dialysis patients or patients that are just never gonna hang around the 30 range, that is my other bucket. yep, I do like Juluca if it can be used, but it can't for everyone. Tivicay is typically in the regimen, and Prezista/Norvir are still a go-to, and I do use Prezcobiz as well.   Pifeltro (doravirine) has no dose adjustment down to a clearance of 15 and the only reason it is not recommended for dialysis patients is only because there are no data, so I am very hopeful that in the non-rilpivirine patients we will have an alternative for a two drug, non boosted regimen of Pifeltro and Tivicay for dialysis patients.

    a great website I have used is: http://hivinsite.ucsf.edu/InSite?page=md-rr-18#S2.6X    -- while it is not completely up to date with the newer medications, it does have great information in 1 place with references.

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    Angela Kapalko
    Physician Assistant Chairperson for AAHIVM
    Philadelphia FIGHT CommunityHealth Centers
    Philadelphia PA
    akapalko@fight.org
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  • 3.  RE: ART Choice with Chronic Kidney Disease

    Posted 04-02-2020 17:28
    The following co-formulations are also indicated to be given in pts with CLcr <15 mL/min who are on hemodialysis:

    Genvoya (TAF/FTC/elvitegravir/cobicistat) one tab daily

    Descovy (TAF/FTC) one tablet daily

    They are still NOT indicated in pts with CLcr 30 mL/min if they are NOT on dialysis.

    Regards,

    Cristina Gruta, PharmD

    360: The UCSF Wellness Center

    350 Parnassus Ave; Ste 908

    San Francisco, CA 94143-0378

    415.353.2119 p

    415.353.2406 f






  • 4.  RE: ART Choice with Chronic Kidney Disease

    Posted 04-09-2020 01:16
      |   view attached
      I've recommended Triumeq (dolutegravir/abacavir/lamivudine) for some of my patients with hemodialysis. There's a relatively small study which found it was tolerated and effective for people with ESRD on HD. 

    Dena Dillon, Pharm.D., AAHIVP




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