J HERON1, H MCMANUS2, T VICKERS2, K RYAN4,5, E WRIGHT5, A CARTER2, M STOOVE5, J ASSELIN5, A GRULICH2, B DONOVAN2, R GUY2, C O’CONNOR2, D GRACEY1,3
1Department of Renal Medicine, Royal Prince Alfred Hospital, 2Kirby Institute, 3Central Clinical School, University of Sydney, 4Department of Infectious Disease, Alfred Health, 5Burnet Institute
Background: Tenofovir disoproxil fumerate (TDF) is associated with adverse renal outcomes when prescribed for HIV infection. There are few data concerning real-world renal outcomes amongst patients prescribed TDF for PrEP. We compare rates of chronic kidney disease (CKD) amongst patients prescribed TDF for HIV infection and PrEP.
Methods: De-identified data were extracted from 52 sexual health clinics across Australia from 2009-2019. All patients prescribed TDF-containing ART were included. Rates of CKD were calculated for patients prescribed TDF for HIV infection and PrEP for up to three years of follow-up. Risk factors were assessed using Cox-proportional hazards models. Sensitivity analysis of risk using 1:1 propensity-score matching to adjust for potential imbalance in HIV- and PrEP-cohorts was conducted.
Results: 5,973 patients on PrEP and 1,973 patients with HIV were included. There were 40 (0.7%) instances of CKD in the PrEP group and 81 (4.1%) in the HIV group (hazard ratio [HR]:0.36 95% confidence interval [CI]:0.23-0.57). Rates of CKD were 0.41/100 person-years of follow-up (95%CI:0.31-0.56) in the PrEP group and 1.62/100 person-years of follow-up (95%CI:1.30-2.01) in the HIV group (p<0.001). CKD was predicted by: age (40-49yr (HR:5.16 95%CI:2.16-12.37), 50-82yr (HR:13.95 95%CI:6.02-32.29) compared to 30-39yr), baseline eGFR<90ml/min (HR:62.14 95%CI:19.58-197.26), hypertension (HR:3.71 95%CI:1.27-10.80), and diabetes (HR:11.16 95%CI:3.28-38.04). After adjusting for age, baseline eGFR<90ml/min and diabetes, the rate of CKD was not lower in the PrEP-cohort (aHR:0.71 95%CI:0.44-1.13, p=0.14). In propensity-matched analysis using 1,620 participants per cohort, increased CKD risk was found in the HIV-cohort (log-rank p=0.001).
Conclusion: Patients prescribed TDF-based PrEP have lower rates of CKD than patients prescribed TDF for HIV infection. In propensity analysis, after matching for risk factors, rates of CKD remained higher amongst patients with HIV.
Jack Heron is an Advanced Trainee in Nephrology at Royal Prince Alfred Hospital and Liverpool Hospital.