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.
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In Gilead study GS-US-292-1825, Genvoya remained effective through 96 wks in 55 virologically-suppressed adults on HD for ESRD. FTC exposure was significantly higher than in pts with normal renal function.Efficacy was also maintained in 10 pts who switched to Biktarvy for 48 wks in the extension phase of the study. Higher FTC and tenofovir concentrations and lower BIC trough were observed (compared to pts with normal renal function) but BIC trough still 4-7x higher than effective concentration. No adverse reactions leading to stopping Biktarvy.Tenofovir and FTC are eliminated by renal excretion. BIC is eliminated by hepatic metabolism (~1% renal).
Eron JJ, et al. A daily single tablet regimen (STR) of bictegravir/emtricitabine/ tenofovir alafenamide (B/F/TAF) in virologically-suppressed adults living with HIV and end stage renal disease on chronic hemodialysis. IDWeek 2020, October 22-25, 2020. Abstract 1002.
Eron JJ, et al. Safety of elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide in HIV-1-infected adults with end-stage renal disease on chronic haemodialysis: an open-label, single-arm, multicentre, phase 3b trial. Lancet HIV. 2018 Dec 13;S2352-3018(18)30296-0.