Background
Since 1-Jan-2018, publicly-funded oral HIV Pre-Exposure Prophylaxis (PrEP) with generic emtricitabine-tenofovir disoproxil fumarate (FTC-TDF) has been available to key HIV populations in British Columbia (BC). We examined the renal safety of over 10,000 clients on FTC-TDF in BC’s population-level PrEP program.
Methods
Using data from BC’s PrEP program, we included clients with ≥1 FTC-TDF PrEP prescription dispensed between 1-Jan-2018 and 31-Dec-2023 and with ≥ 1 follow up eGFR at least 7 days after first PrEP dispense (study follow-up to 30-Jun-2024). Clients with follow-up eGFR <60mL/min at least twice, 30 days apart, and clients with ≥1 severely increased urine albumin/creatinine ratio value (uACR >30mg/mmol) subsequent to first PrEP dispense, were determined.
Results
A total of 10,267 clients were included [median age 32 (Q1-Q3, 27-40) years; 97% cis-men, 1.5% trans-women (TGW); 0.7% cis-women; 0.4% trans-men; 0.4% nonbinary]. 98% were men who have sex with men [MSM] or TGW with median HIRI-MSM score 18 (Q1-Q3, 15-22), and 12% reported PrEP use prior to program enrolment. Median baseline eGFR was 104 (Q1-Q3, 90-116) mL/min, with 33 (0.3%) clients with baseline eGFR <60mL/min at program enrolment, including 4 clients with eGFR <50mL/min. Median follow-up time was 22 (Q1-Q3, 9-47) months, and the median eGFR testing rate was 3.4 (Q1-Q3, 2.1-4.5) tests per person year. There was a median of 5 (Q1-Q3, 2-10) PrEP dispenses per client with an estimated median 81% (Q1-Q3, 49-97) proportion of days covered by PrEP medication during client follow-up. Overall, 151 (1.5%) of clients had incident eGFR <60mL/min at least twice consecutively, at median 24 (range 4-68) months (See Figure). For these clients, 97% were cis-men, median age was 56 (range 27-81) years, and baseline eGFR was median 68 (range 42-121) mL/min. Of the 2470 (24%) clients with ≥1 uACR result available, 31 (1.2%) had a value >30mg/mmol reported.
Conclusions
Over 6 years of BC’s population-level HIV PrEP program, we found that incident decreased renal function was infrequent amongst clients, with most cases occurring >6 months after PrEP initiation. Due to the overall safety of FTC-TDF, the quarterly frequency of renal monitoring may be re-evaluated in young PrEP users with normal baseline renal function. For individuals experiencing renal adverse effects, novel PrEP agents may offer an alternative.