Pozniak, AntonArribas, Jose R.Gathe, JosephGupta, Samir K.Post, Frank A.Bloch, MarkAvihingsanon, AnchaleeCrofoot, GordonBenson, PaulLichtenstein, KennethRamgopal, MotiChetchotisakd, PloenchanCustodio, Joseph M.Abram, Michael E.Wei, XuelianCheng, AndrewMcCallister, ScottSenGupta, DeviFordyce, Marshall W.2016-09-162016-09-162016-04-15Pozniak, A., Arribas, J. R., Gathe, J., Gupta, S. K., Post, F. A., Bloch, M., … Fordyce, M. W. (2016). Switching to Tenofovir Alafenamide, Coformulated With Elvitegravir, Cobicistat, and Emtricitabine, in HIV-Infected Patients With Renal Impairment: 48-Week Results From a Single-Arm, Multicenter, Open-Label Phase 3 Study. Journal of Acquired Immune Deficiency Syndromes (1999), 71(5), 530–537. http://doi.org/10.1097/QAI.00000000000009081944-7884https://hdl.handle.net/1805/10946BACKGROUND: Tenofovir alafenamide (TAF) is a novel tenofovir prodrug with improved renal and bone safety compared with TDF-containing regimens. We report the 48 week safety and efficacy of a once-daily single tablet regimen of elvitegravir 150 mg (E), cobicistat 150 mg (C), emtricitabine 200 mg (F), and TAF 10 mg (E/C/F/TAF) in HIV-1-infected patients with mild to moderate renal impairment. METHODS: We enrolled virologically suppressed HIV-1-infected subjects with estimated creatinine clearance (CrCl) 30-69 mL/min in a single-arm, open-label study to switch regimens to E/C/F/TAF. The primary endpoint was the change from baseline in glomerular filtration rate estimated using various formulae. This study is registered with ClinicalTrials.gov, number NCT01818596. FINDINGS: We enrolled and treated 242 patients with mean age 58 years, 18% Black, 39% hypertension, 14% diabetes. Through week 48, no significant change in estimated CrCl was observed. Two patients (0.8%) discontinued study drug for decreased creatinine clearance, neither had evidence of renal tubulopathy and both had uncontrolled hypertension. Subjects had significant improvements in proteinuria, albuminuria, and tubular proteinuria (P < 0.001 for all). Hip and spine bone mineral density significantly increased from baseline to week 48 (mean percent change +1.47 and +2.29, respectively, P < 0.05). Ninety-two percent (222 patients) maintained HIV-1 RNA <50 copies per milliliter at week 48. INTERPRETATION: Switch to E/C/F/TAF was associated with minimal change in GFR. Proteinuria, albuminuria and bone mineral density significantly improved. These data support the efficacy and safety of once daily E/C/F/TAF in HIV+ patients with mild or moderate renal impairment without dose adjustment.en-USAttribution-NonCommercial-NoDerivatives 4.0 InternationalCobicistattherapeutic useEmtricitabineHIV Infectionsdrug therapyQuinolonesRenal Insufficiencyprevention & controlTenofovirArticle