Academy Exchange

I have a patient who has had declining GFR while on Biktarvy.  A consultation with a nephrologist confirmed Tenofovir Alafenamide renal toxicity.  The patient is HLA B *5701 Positive and cannot take abacavir.  He is Hep B Core and Surface Ab  positive and Surface Ag negative.   I would like to switch him to an integrase Strand Inhibitor (Dolutegravir) and boosted PI (Darunavir/ Retonavir) regime  I would consider raltegravir but I do not know his original HIV PCR count nor his original T Cell count.   I would appreciate any experience with this switch. 

Thanks

Richard Wulfsberg, MD   Los Angeles

I have a patient who has had declining GFR while on Biktarvy.  A consultation with a nephrologist confirmed Tenofovir Alafenamide renal toxicity.  The patient is HLA B *5701 Positive and cannot take abacavir.  He is Hep B Core and Surface Ab  positive and Surface Ag negative.   I would like to switch him to an integrase Strand Inhibitor (Dolutegravir) and boosted PI (Darunavir/ Retonavir) regime  I would consider raltegravir but I do not know his original HIV PCR count nor his original T Cell count.   I would appreciate any experience with this switch. 

Thanks

Richard Wulfsberg, MD   Los Angeles

I have a patient who has had declining GFR while on Biktarvy.  A consultation with a nephrologist confirmed Tenofovir Alafenamide renal toxicity.  The patient is HLA B *5701 Positive and cannot take abacavir.  He is Hep B Core and Surface Ab  positive and Surface Ag negative.   I would like to switch him to an integrase Strand Inhibitor (Dolutegravir) and boosted PI (Darunavir/ Retonavir) regime  I would consider raltegravir but I do not know his original HIV PCR count nor his original T Cell count.   I would appreciate any experience with this switch. 

Thanks

Richard Wulfsberg, MD   Los Angeles

I have a patient who has had declining GFR while on Biktarvy.  A consultation with a nephrologist confirmed Tenofovir Alafenamide renal toxicity.  The patient is HLA B *5701 Positive and cannot take abacavir.  He is Hep B Core and Surface Ab  positive and Surface Ag negative.   I would like to switch him to an integrase Strand Inhibitor (Dolutegravir) and boosted PI (Darunavir/ Retonavir) regime  I would consider raltegravir but I do not know his original HIV PCR count nor his original T Cell count.   I would appreciate any experience with this switch. 

Thanks

Richard Wulfsberg, MD   Los Angeles

Hi Richard,

If you want to change to a regimen that avoids tenofovir, you could certainly go with Tivicay and Prezcobix.  But one tablet a day options would include Dovato (if no M184V) and Juluca (as long as there are no rilpivirine RAMs and he can take this with a meal, and he is on no anti reflux meds).  Cabenuva would also be a consideration, if he is otherwise appropriate for this regimen.  He appears not to have chronic HBV.  These meds will obviously not treat chronic HBV.

Let me just add this.  I find that specialists will occasionally blame HIV meds for an issue inappropriately.  It is unusual, but not impossible, for TAF to worsen kidney function significantly.   You might want to make sure that there is no other explanation for worsening kidney function.  Hope that helps.  

I have a patient who has had declining GFR while on Biktarvy.  A consultation with a nephrologist confirmed Tenofovir Alafenamide renal toxicity.  The patient is HLA B *5701 Positive and cannot take abacavir.  He is Hep B Core and Surface Ab  positive and Surface Ag negative.   I would like to switch him to an integrase Strand Inhibitor (Dolutegravir) and boosted PI (Darunavir/ Retonavir) regime  I would consider raltegravir but I do not know his original HIV PCR count nor his original T Cell count.   I would appreciate any experience with this switch. 

Thanks

Richard Wulfsberg, MD   Los Angeles

Hi Richard,

If you want to change to a regimen that avoids tenofovir, you could certainly go with Tivicay and Prezcobix.  But one tablet a day options would include Dovato (if no M184V) and Juluca (as long as there are no rilpivirine RAMs and he can take this with a meal, and he is on no anti reflux meds).  Cabenuva would also be a consideration, if he is otherwise appropriate for this regimen.  He appears not to have chronic HBV.  These meds will obviously not treat chronic HBV.

Let me just add this.  I find that specialists will occasionally blame HIV meds for an issue inappropriately.  It is unusual, but not impossible, for TAF to worsen kidney function significantly.   You might want to make sure that there is no other explanation for worsening kidney function.  Hope that helps.  

I have a patient who has had declining GFR while on Biktarvy.  A consultation with a nephrologist confirmed Tenofovir Alafenamide renal toxicity.  The patient is HLA B *5701 Positive and cannot take abacavir.  He is Hep B Core and Surface Ab  positive and Surface Ag negative.   I would like to switch him to an integrase Strand Inhibitor (Dolutegravir) and boosted PI (Darunavir/ Retonavir) regime  I would consider raltegravir but I do not know his original HIV PCR count nor his original T Cell count.   I would appreciate any experience with this switch. 

Thanks

Richard Wulfsberg, MD   Los Angeles

I have a patient who has had declining GFR while on Biktarvy.  A consultation with a nephrologist confirmed Tenofovir Alafenamide renal toxicity.  The patient is HLA B *5701 Positive and cannot take abacavir.  He is Hep B Core and Surface Ab  positive and Surface Ag negative.   I would like to switch him to an integrase Strand Inhibitor (Dolutegravir) and boosted PI (Darunavir/ Retonavir) regime  I would consider raltegravir but I do not know his original HIV PCR count nor his original T Cell count.   I would appreciate any experience with this switch. 

Thanks

Richard Wulfsberg, MD   Los Angeles

I have a patient who has had declining GFR while on Biktarvy.  A consultation with a nephrologist confirmed Tenofovir Alafenamide renal toxicity.  The patient is HLA B *5701 Positive and cannot take abacavir.  He is Hep B Core and Surface Ab  positive and Surface Ag negative.   I would like to switch him to an integrase Strand Inhibitor (Dolutegravir) and boosted PI (Darunavir/ Retonavir) regime  I would consider raltegravir but I do not know his original HIV PCR count nor his original T Cell count.   I would appreciate any experience with this switch. 

Thanks

Richard Wulfsberg, MD   Los Angeles

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Richard Wulfsberg
Encino CA
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I have a patient who has had declining GFR while on Biktarvy.  A consultation with a nephrologist confirmed Tenofovir Alafenamide renal toxicity.  The patient is HLA B *5701 Positive and cannot take abacavir.  He is Hep B Core and Surface Ab  positive and Surface Ag negative.   I would like to switch him to an integrase Strand Inhibitor (Dolutegravir) and boosted PI (Darunavir/ Retonavir) regime  I would consider raltegravir but I do not know his original HIV PCR count nor his original T Cell count.   I would appreciate any experience with this switch. 

Thanks

Richard Wulfsberg, MD   Los Angeles

Being that he is Hep B Ab positive and having kidney issues… I would recommend Dolutegravir and Doravirine… it's my favorite none boosted regimen that is tolerated VERY well and can be given to all with CKD regardless of initial HIV Viral Load! Hope this helps!

I have a patient who has had declining GFR while on Biktarvy.  A consultation with a nephrologist confirmed Tenofovir Alafenamide renal toxicity.  The patient is HLA B *5701 Positive and cannot take abacavir.  He is Hep B Core and Surface Ab  positive and Surface Ag negative.   I would like to switch him to an integrase Strand Inhibitor (Dolutegravir) and boosted PI (Darunavir/ Retonavir) regime  I would consider raltegravir but I do not know his original HIV PCR count nor his original T Cell count.   I would appreciate any experience with this switch. 

Thanks

Richard Wulfsberg, MD   Los Angeles