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Squillace N, Ricci E, Maggi P, Taramasso L, Menzaghi B, De Socio GV, Piconi S, Maurizio Celesia B, Orofino G, Sarchi E, Pellicanò GF, Simeone F, Valsecchi L, Bandera A, Cenderello G, Attala L, Angioni G, Falasca K, Cascio A, Bargiacchi O, Di Biagio A, Bonfanti P. Real-life safety of Emtricitabine/Tenofovir Alafenamide/Bictegravir. PLoS One 2023; 18:e0289132. [PMID: 37556481 PMCID: PMC10411741 DOI: 10.1371/journal.pone.0289132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/08/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Integrase strand transfer inhibitors (INSTI) are one of the most prescribed drug classes for the treatment of HIV infection worldwide. Emtricitabine/Tenofovir Alafenamide/ Bictegravir (FTC/TAF/BIC) has been evaluated in randomized clinical trials; few studies have verified tolerability and safety in clinical practice. Our aim was to investigate the metabolic and hepatic safety in a real-life setting of FTC/TAF/BIC. MATERIALS AND METHODS Consecutive people living with HIV infection (PLWH) enrolled in the SCOLTA project, switching to or initiating their first antiretroviral treatment with FTC/TAF/BIC were included. PLWH with HBV co-infection were excluded. Metabolic and hepatic variables were collected at T0 and T1, were defined as baseline and 6-month follow-up respectively, and their modifications were analysed using the paired t-test and the analysis of variance. RESULTS Five hundred and thirty-nine PLWH with at least one follow-up visit were included in the analysis. Mean age was 48 years (±12.1), 74% were male, 16.1% were naïve to antiretrovirals (ART). At T1, ART-experienced PLWH showed a significant reduction of total cholesterol (TC) and triglycerides, and a slight increase in blood glucose (BG) and ALT. On the contrary, in ART-naïve PLWH blood lipids significantly increased, although with an unaffected TC/high density lipoprotein (HDL)-c ratio, while alanine aminotransferase (ALT) decreased significantly, mainly in those with altered baseline level. The treatment interruptions were 45 (8.4%) over the whole observation period, 13 (2.4%) due to AEs. The most frequent AEs were related to the central nervous system (6 events of depression, insomnia, headache, agitation) and 3 PLWH discontinued the regimen because of grade 1-2 weight gain. CONCLUSIONS In ART-experienced PLWH switching to FTC/TAF/BIC a significant improvement of lipid profile occurred but with significant BG and ALT variation without clinical relevance. In ART-naïve PLWH, blood lipids increased even though lipid profile did not worsen, and a trend towards normalization of liver enzymes was suggested. FTC/TAF/BIC is well tolerated in the real life setting.
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Affiliation(s)
- Nicola Squillace
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Elena Ricci
- Fondazione ASIA Onlus, Buccinasco (MI), Italy
| | - Paolo Maggi
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, Caserta, Italy
| | - Lucia Taramasso
- Infectious Diseases, San Martino Hospital Genoa, University of Genoa, Genoa, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio (VA), Italy
| | | | - Stefania Piconi
- Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy
| | | | - Giancarlo Orofino
- Division I of Infectious and Tropical Diseases, ASL Città di Torino, Torino, Italy
| | - Eleonora Sarchi
- Infectious Diseases Unit, S.Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | - Filomena Simeone
- Infectious Diseases Unit, AORN Sant’Anna e San Sebastiano, Caserta, Italy
| | - Laura Valsecchi
- 1st Department of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Alessandra Bandera
- Infectious Disease Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Letizia Attala
- SOC 1 USLCENTRO FIRENZE, Unit of Infectious Diseases, Santa Maria Annunziata Hospital, Florence, Italy
| | | | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, G. D’Annunzio University, Chieti-Pescara, Chieti, Italy
| | - Antonio Cascio
- Unit of Infectious Diseases, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Olivia Bargiacchi
- Unit of Infectious Diseases, Ospedale Maggiore della Carità, Novara, Italy
| | - Antonio Di Biagio
- Infectious Diseases, San Martino Hospital Genoa, University of Genoa, Genoa, Italy
| | - Paolo Bonfanti
- Infectious Diseases Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Department of Medicine, University of Milano-Bicocca, Milano (MI), Italy
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Squillace N, Ricci E, Quirino T, Gori A, Bandera A, Carenzi L, De Socio GV, Orofino G, Martinelli C, Madeddu G, Rusconi S, Maggi P, Celesia BM, Cordier L, Vichi F, Calza L, Falasca K, Di Biagio A, Pellicanò GF, Bonfanti P. Safety and tolerability of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil fumarate in a real life setting: Data from surveillance cohort long-term toxicity antiretrovirals/antivirals (SCOLTA) project. PLoS One 2017. [PMID: 28632758 PMCID: PMC5478131 DOI: 10.1371/journal.pone.0179254] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objectives The study aim was to evaluate the impact on Liver and Kidney toxicity of the single tablet regimen Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Disoproxil Fumarate (EVG/COBI/FTC/TDF) on Antiretroviral Therapy (ART) experienced or naïve patients. Methods Patients initiating EVG/COBI/FTC/TDF were enrolled in the SCOLTA project, a multicenter observational study reporting grade 3–4 Adverse Events in subjects beginning new antiretroviral drug regimens. In this analysis, patients were evaluated at T0 (baseline), T1 (six months) and at T2 (twelve months). Results A total of 329 patients were enrolled, and 280 (85.1%) of these had at least one follow-up visit. Median observation time was 11 months (IQR 7.0–15.5). Two hundred and two patients (72.1%) were ART experienced and 78 (27.9%) ART naive. Prevalence of HCV-co-infection was 21.4%. At T1, we observed a significant decline in estimated glomerular filtration rate (eGFR), both in experienced and naive patients (mean change from T0–7.5 ± 12.8 ml/min, -15.5 ± 17.8 ml/min, respectively, p = 0.0005), which was confirmed at T2 (mean change from T0–8.2 ± 15.8 ml/min, -17.6 ± 19.4 ml/min, respectively, p = 0.001). Regarding aspartate aminotransferase (AST) and alanine transaminase (ALT) grade 1–2 modifications, no significant differences were observed between experienced and naïve subjects, but an increased prevalence of abnormal liver function test was observed in patients with chronic HCV infection (p<0.001). Conclusions A significant decline in eGFR was observed in patients initiating EVG/COBI/FTC/TDF in the first 6 months, with no significant worsening occurring at 12 months vs. 6 months of therapy. Patients with chronic HCV infection were at higher risk to develop abnormal liver tests.
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Affiliation(s)
- Nicola Squillace
- Infectious Diseases Clinic, Azienda Socio Sanitaria Territoriale di MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
- * E-mail:
| | - Elena Ricci
- Department of Infectious Diseases, Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Milano, Italy
| | - Tiziana Quirino
- Unit of Infectious Diseases, Azienda Socio Sanitaria Territoriale della Valle Olona–Busto Arsizio (VA), Italy
| | - Andrea Gori
- Infectious Diseases Clinic, Azienda Socio Sanitaria Territoriale di MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Alessandra Bandera
- Infectious Diseases Clinic, Azienda Socio Sanitaria Territoriale di MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy
| | - Laura Carenzi
- Department of Infectious Diseases, Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Milano, Italy
| | | | - Giancarlo Orofino
- Unit of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy
| | | | - Giordano Madeddu
- Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Stefano Rusconi
- Infectious Diseases, Department of Biomedical and Clinical Science Luigi Sacco, University of Milan, Milan, Italy
| | - Paolo Maggi
- Infectious Disease Clinic, University of Bari, Italy
| | | | - Laura Cordier
- Department of Infectious Diseases, Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Milano, Italy
| | - Francesca Vichi
- Unit of Infectious Diseases, Santa Maria Annunziata Hospital, Firenze, Italy
| | - Leonardo Calza
- Department of Infectious Diseases, S.Orsola Malpighi Hospital, Bologna, Italy
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Antonio Di Biagio
- Infectious Diseases, San Martino Hospital Genoa, University of Genoa, Genoa, Italy
| | | | - Paolo Bonfanti
- Unit of Infectious Diseases, A. Manzoni Hospital, Lecco, Italy
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