Academy Exchange

Expand all | Collapse all

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



    ------------------------------
    Gary F. Spinner PA,MPH,AAHIVS
    Southwest Community Health Center
    Bridgeport, CT
    gspinner@swchc.org
    Gary.spinner@aya.yale.edu
    ------------------------------


  • 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.

    ------------------------------
    Angela Kapalko
    Physician Assistant Chairperson for AAHIVM
    Philadelphia FIGHT CommunityHealth Centers
    Philadelphia PA
    akapalko@fight.org
    ------------------------------



  • 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




    Notice: This UI Health Care e-mail (including attachments) is covered by the Electronic Communications Privacy Act, 18 U.S.C. 2510-2521 and is intended only for the use of the individual or entity to which it is addressed, and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If you are not the intended recipient, any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the sender immediately and delete or destroy all copies of the original message and attachments thereto. Email sent to or from UI Health Care may be retained as required by law or regulation. Thank you.





  • 5.  RE: ART Choice with Chronic Kidney Disease

    Posted 12-02-2020 10:41
    Is anyone using Biktarvy in their dialysis pts? I'm considering it...


    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.



    ------------------------------
    Elliot Goodenough
    Philadelphia PA
    ------------------------------



  • 6.  RE: ART Choice with Chronic Kidney Disease

    Posted 12-02-2020 20:32
    In India we use abc and 3tc according to creatinine clearance .


    Jeetesh




  • 7.  RE: ART Choice with Chronic Kidney Disease

    Posted 12-03-2020 18:07
    I use Juluca. If they are on Hemodialysis I do not have an issue with using Genvoya. Not too long ago, data supported the effectiveness of Genvoya in ESRD/HD

    ------------------------------
    Amber Siegel MSN APRN AGNP-C
    Orlando, Florida
    ------------------------------



  • 8.  RE: ART Choice with Chronic Kidney Disease

    Posted 12-03-2020 22:48
    We use really adjusted dose of 3tc here . Abc is good , taf is excellent

    Jeetesh