Open AccessTenofovir alafenamide: An initial experience at Groote Schuur Hospital, Cape Town, South Africa
Author(s) -
Alexander Geragotellis,
Shama Patel,
Mark Sonderup,
Nicola Wearne,
Zibya Barday,
L Sanglay,
Vimla Naicker,
C W Spearman
Publication year - 2022
Publication title -
samj. south african medical journal/south african medical journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.527
H-Index - 57
eISSN - 2078-5135
pISSN - 0256-9574
DOI - 10.7196/samj.2022.v112i2.16188
Subject(s) - medicine , interquartile range , renal function , tenofovir alafenamide , creatinine , lamivudine , hbsag , kidney disease , hepatitis b , gastroenterology , hepatitis b virus , surgery , human immunodeficiency virus (hiv) , viral load , immunology , antiretroviral therapy , virus
Background. Hepatitis B virus (HBV) remains endemic in South Africa (SA), with a concomitantly high prevalence of HIV co-infection. Chronic kidney disease in these subpopulations also has a high prevalence. Tenofovir is an important component of management, but the associated risk of nephrotoxicity makes dosing a challenge in patients with impaired kidney function. A new formulation, tenofovir alafenamide fumarate (TAF), with a more favourable renal toxicity profile, is now available. Objectives. To evaluate our initial experience of TAF use at Groote Schuur Hospital, Cape Town. Methods. We retrospectively reviewed patients with HBV mono-infection and HIV-HBV co-infection who were initiated on TAF since 2018. We recorded all relevant demographic, serological, virological and biochemical data from patient records. Adherence was documented by pill collection at the pharmacy. Results. A total of 26 patients were included in the evaluation, median (interquartile range (IQR)) age 48 (39 - 51) years, 73% (n=19) male, 27% (n=7) hepatitis B e-antigen-positive, and 46% (n=12) HIV co-infected. The median (IQR) duration of treatment with TAF was 13 (9 - 15) months. The median (IQR) baseline creatinine level was 180 (130 - 227) µmol/L, with significant improvement at 12 months, 122 (94 - 143) µmol/L; p=0.017. Reflecting this change, the estimated glomerular filtration rate improved significantly from baseline to month 12 (42 (25 - 52) and 51 (48 - 68) mL/min/1.73 m2, respectively; p=0.023). Similarly, serum alanine aminotransferase (ALT) normalised from a baseline of 33 (18 - 52) to 18 (15 - 24) U/L at month 12 (p=0.012). HBV DNA viral load also declined, from a baseline of log10 4.04 (2.5 - 7.8) IU/mL to a median of <log10 1.3 IU/mL at month 12. HIV viral load was less than the lower level of quantification at months 6 and 12. Conclusions. TAF was well tolerated, with stable and significantly improving kidney function throughout a 12-month follow-up period. Serum ALT normalised, mirrored by declining HBV viral load. HIV viral load remained undetectable at 6 and 12 months.