Kidney function and TAF

[an92]

I'm wondering what other people think about TAF in modern drugs, such as the Descovy I'm taking.

Does it damage the kidneys bad? I know the research says it's "safer", but what are people's experiences?

I just started treatment a month ago, and my first labs show an increase in creatine, and a decrease in GFR? They are all still in the safe reference range, but still there is a significant movement. Should I be worried??

Creatine: (range 62 - 106)
Before treatment: 73
After 2 weeks of treatment: 86

GFR: (above 60 is healthy)
Before treatment: 123
After 2 weeks of treatment: 108

Ideally I don't want to switch as I don't have side effects with my combination of Descovy and Tivicay. I have my next labs next week (5 weeks of treatment) and I'm a bit anxious about the impact on kidney function.

[Jim Allen]

Its monitored, as in you will at some point move towards check-ups every 6 months so if it ever does become an issue for you than it will be picked up early and you can switch and change. Its common to see it go up and than settle somewhat after switching or starting meds, but it levels out. The levels you have are within "normal" range.

It would not surprise me if millions of people have taken TAF or TDF before you, its been around for a while and 10000 still do today and will continue to do so as part of PrEP & PEP or for the time being HIV treatment. Its a drug with plenty of headlines and controversy ill give you that, that said newer drugs will come and replace this and even the replacement will be replaced at some stage.   

The people who have to worry about TAF from the start are people with pre-existing kidney damage/conditions. If your doctor is not worried than I would not be worried either, there is no need to switch or worry about switching if its working for you.

Personally speaking TAF or TDF would not suit me, but i am just a drop in the ocean and my experience is nothing for anyone else to stress about.

Why the continued concerns? I mean your treatment is going well, you have settled in nicely, and the labs are looking great, and your HIV is having its backside kicked by the meds, so why the doubts/fears ?

Anyhow that's my two cents on it.

Jim

[OREGONISTANBUL]

I'm wondering what other people think about TAF in modern drugs, such as the Descovy I'm taking.

Does it damage the kidneys bad? I know the research says it's "safer", but what are people's experiences?

I just started treatment a month ago, and my first labs show an increase in creatine, and a decrease in GFR? They are all still in the safe reference range, but still there is a significant movement. Should I be worried??

Creatine: (range 62 - 106)
Before treatment: 73
After 2 weeks of treatment: 86

GFR: (above 60 is healthy)
Before treatment: 123
After 2 weeks of treatment: 108

Ideally I don't want to switch as I don't have side effects with my combination of Descovy and Tivicay. I have my next labs next week (5 weeks of treatment) and I'm a bit anxious about the impact on kidney function.

These are minor changes. No need to worry about. I was on Stribild for 1 year and a half then switched to Genvoya. No severe problems or changes so far in creatine or egfr except some minor ups and downs (both on TDF or TAF) and i would suggest you not to monitor every value in short periods as it will become an endless effort.. Stay undetectable. This is what counts most.

OREGON

[an92]

Thank you for the advice Jim and Oregon! And thanks for reassuring me.
I’m having my second ever viral load test post treatment (5 weeks ) next week and I’m really hoping it will be undetectable (less than 20).
As you can see from my posts, I am not prone to depression, but I am prone to worrying 

Continuing with the theme of TAF, I’ve been reading around (and I probably shouldn’t have) and I came across some studies that said there was around 15% chance of becoming resistant in the first year. Now that scared me a lot, because most of the newer combination drugs contain TAF such as genvoya, odefsey etc. Is it really such a problem with resistance? Do people become resistant if they are adherent to all the doses and always on time ?

My resistance tests showed that I have an inherited resistance to protease inhibitors. Is this going to be a big problem for me, is it going to really limit my options if for example I had a problem with tenofovir TAF down the line as well? I don’t want to end up with no modern options and have to take the old drugs with side effects. That scares me.

Sorry, just venting. I’m going to think positive  hopefully I stay undetected with no problems!! 

[Jim Allen]

I came across some studies that said there was around 15% chance of becoming resistant in the first year.

Link ? 15% ...? 

My two cents, your overthinking things and I don't say that to dismiss your concerns but I do think some of it lacks a bit of context/perspective.   

As far as I know there is not even 15% virologic failure rates in this day and age (used to be higher prehaps, pill burden and the meds were harder) but even virologic failure rates does not always equal drug resistance, Virologic failure rates is driven simply when antiretroviral therapy (ART) fails to suppress and sustain a person’s viral load this would include resistance issues.

Okay lets presume its correct, 15% sounds very much on the high side nowadays but okay.

Context?

Many factors that can contribute to "virologic failure" and than lead to "resistance" including, drug resistance from the start as this is not always tested beforehand and discovered down the line this would add to the overall % (You were tested)

Poor treatment adherence, (despite reporting adherence), Underlying medical conditions, underlying medical treatments (interactions) and/or poor absorption, Drugs and/or alcohol dependency, untreated (unsupported) mental health issues.

Now if you take that away or if you do have those challenges you act and do something about them you are left with a tiniest fraction that have an issue.

Also the odd few who can't reach UD despite doing everything right, they are switched. 

Now all in all, you were tested and now you are on a treatment that will work and as long as you are adherent to your meds you will be fine, virologic failure and resistance should not be an issue.

Jim

https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv/15/virologic-failure

Patient/Adherence-Related Factors (see Adherence to the Continuum of Care)

Comorbidities that may affect adherence (e.g., active substance abuse, mental health disorders, neurocognitive impairment)
Unstable housing and other psychosocial factors
Missed clinic appointments
Interruption of or intermittent access to ART
Cost and affordability of ARVs (i.e., may affect ability to access or continue therapy)
Drug adverse effects
High pill burden and/or dosing frequency
HIV-Related Factors

Presence of transmitted or acquired drug-resistant virus documented by current or past resistance testing
Prior treatment failure
Innate resistance to ARVs based on tropism or the presence of HIV-2 infection/co-infection.
Higher pretreatment HIV RNA level (some regimens may be less effective)
ARV Regimen-Related Factors

Suboptimal pharmacokinetics (variable absorption, metabolism, or possible penetration into reservoirs)
Suboptimal virologic potency
Low genetic barrier to resistance
Reduced efficacy due to prior exposure to suboptimal regimens (e.g., monotherapy, dual-nucleoside therapy, or the sequential introduction of drugs)
Food requirements
Adverse drug-drug interactions with concomitant medications
Prescription errors

https://www.poz.com/basics/hiv-basics/hiv-drug-resistance

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4839839/