Question
Should I switch treatment due to declining kidney function?
18 December 2023. Related: All topics, CD4 and viral load, Changing treatment.
Should I switch treatment due to declining kidney function?
I have been on a boosted protease inhibitor (Ritonavir and Lopinavir) plus TDF and 3TC for about 7 years (Since I got diagnosed). My VL has been stable and undetectable all this time (less than 40.) CD4 has increased from an initial pre-treatment of below 200 to now in the range of 500. Finally, baseline VL was about 5 million when I started pre-treatment.
Concern – my serum creatinine seems to be declining mildly through the years but stabilized at about the 1.2 mg/dl range in the last 4 years. This year it has declined to a new high of 1.4 mg/dl. My doc also requested a cystatin C test recently but that shows a more normal range (just on the the upper limit).
Should I switch to a NON-TDF based regimen? A treatment with TAF (BIKTARVY) is right now avail here in my country. What are the risks of treatment failure from switching?
Answer
Hi, how are you doing?
It is great to hear how well you have been doing on treatment.
As you have mentioned that your kidney function has been declining, has it tested out of a healthy range? e.g., above 1.4 mg/dl if you are a man and 1.2 mg/dl if you are a woman.
It is good that the cystatin C test has tested within a normal range.
As you age it is expected for kidney function to slowly decline. As you are still testing in a normal range albeit with a slight increase this is an expected change.
Do you tolerate your treatment well/do you have any problems aside from this change in kidney function on your current regimen?
Switching to Biktarvy is a common switch from boosted combinations. This is because they are generally better tolerated than non-boosted combinations. Moving to a TAF based regimen is kidney-protective and will help to avoid any further risk of treatment causing your kidney function to decline.
Have you been on other treatments before? and have you had any problems with resistance before?
If you have not and switching is recommended, there will be no risk of switching. You can move between these treatments and it will not risk treatment failure or lead to a viral load rebound.
Josh.
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