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. 2024 Mar 1;95(3):255-259.
doi: 10.1097/QAI.0000000000003346.

Brief Report: Incidence and Management of Complex Kidney Situations Among On-Demand and Daily HIV Pre-Exposure Prophylaxis Users

Geoffroy Liegeon  1   2 , Alexandre Brun  3 , Gwenn Hamet  3 , Jeremy Zeggagh  2 , Claire Pintado  2   4 , Bénédicte Loze  2 , Diane Ponscarme  2 , Willy Rozenbaum  3 , Jean-Michel Molina  2   5   6
Affiliations

Brief Report: Incidence and Management of Complex Kidney Situations Among On-Demand and Daily HIV Pre-Exposure Prophylaxis Users

Geoffroy Liegeon et al. J Acquir Immune Defic Syndr. .

Abstract

Background: We evaluated complex pre-exposure prophylaxis (PrEP) situations linked to kidney issues in a cohort of on-demand and daily PrEP users.

Setting: We conducted a single-center retrospective cohort study in France including all PrEP users who received a tenofovir disoproxil (TD)-emtricitabine (FTC) prescription between January 1, 2012 and December 31, 2019 with at least 1 creatinine measurement available before and after PrEP initiation.

Methods: A complex kidney situation (CKS) was defined as an estimated glomerular filtration rate (eGFR) <60 mL/minute/1.73m 2 on 2 consecutive measurements. We estimated the incidence of this event, described case management, and identified associated factors using a Cox model.

Results: Three thousand one hundred and fourteen individuals were included in this study. Almost all were men (99%) with a median age of 35 years, 25% had an eGFR <90 mL/minute/1.73m 2 at baseline, and 65% used on-demand PrEP. Nine users (0.29%) had a CKS at baseline; 8/9 initiated on-demand PrEP without renal function worsening after a median (interquartile range [IQR]) follow-up time of 14 months (7-31). Thirteen cases of CKS occurred during the follow-up for a 0.25 per 100 person-years incidence (95% confidence interval [CI]: [0.14; 0.45]). On-demand PrEP was used in 7/13 participants with no further episode of confirmed eGFR <60 mL/minute/1.73m 2 after a 17-month median follow-up (IQR 4-18). CKS was associated with an age ≥50 years (hazard ratio [HR] 13, 95% CI: [4-39]) or with a baseline eGFR <90 mL/minute/1.73m 2 (HR 34, 95% CI: [4-261]). 9/22 CKS were linked to high-protein intake for weight training.

Conclusions: CKS were rare in our cohort. On-demand PrEP did not result in subsequent renal function worsening in these few situations.

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Conflict of interest statement

J.-M. Molina reports receiving support as an adviser for Gilead Sciences, Merck, Janssen, and ViiV, and research grants from Gilead Sciences. The remaining authors have no funding or conflicts of interest to disclose.

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