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Master Thesis

Étude de la fonction rénale chez les hommes ayant des rapports sexuels avec des hommes initiant une prophylaxie pré-exposition du VIH par tenofovirdisoproxil fumarate / emtricitabine a la demande dans le cadre de l'essai ANRS-IPERGAY

Abstract : Background: We assessed whether on-demand PrEP could increase the renal safety of TDF/FTC based PrEP among MSM. Methods: We used data from the randomized double-blind placebo-controlled ANRS-IPERGAY trial conducted among HIV-uninfected MSM with normal kidney function at baseline starting on-demand TDF/FTC based PrEP. Using linear mixed model, we evaluated the mean eGFR change from baseline during both the blind and the open-label extension phase of the study. Results: During the blind phase, with a median of follow-up of 9.4 months, the mean decline slope of eGFR from baseline was -0.07mL/min/1.73m² per month in the placebo group (n=201) (P=0.04) and -0.13 mL/min/1.73m² per month in the TDF/FTC group (n=198) (P<0.01) for a slope difference of -0.06mL/min/1.73m² per month (P=0.27). Including both phases, 389 participants started on-demand TDF/FTC with a median follow up of 19.2 months. The slope of eGFR reduction was not different in participants with an eGFR at baseline ≤90ml/min/1.73m², an age >40 years or hypertension. There was a dose-response relationship between a high exposure level to tenofovir and a lower eGFR at any time of the study when we considered the cumulative number of pills from baseline, the number of pills per month or the tenofovir’s dosages in plasma (when compared to ≤ 2ng/mL, >2 to ≤10ng/mL: -0.99mL/min/1.73m², >10 to ≤40ng/mL: -1.28mL/min/1.73m², >40ng/mL: -1.82mL/min/1.73m², P<0.001). Conclusion: The eGFR decline over time in on-demand PrEP was similar to the placebo group and was not influenced by age or baseline eGFR. However, higher exposure to TDF was associated with a lower eGFR according to a dose-response relationship.
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Master Thesis
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Geoffroy Liegeon. Étude de la fonction rénale chez les hommes ayant des rapports sexuels avec des hommes initiant une prophylaxie pré-exposition du VIH par tenofovirdisoproxil fumarate / emtricitabine a la demande dans le cadre de l'essai ANRS-IPERGAY. Urologie et Néphrologie. 2019. ⟨dumas-02958337⟩

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