Decline in estimated glomerular filtration rate following substitution of Nevirapine-based regimen with Tenofovir-based regimen in Indonesia

Indonesia started transitioning people living with HIV (PLHIV) from Nevirapine (NVP)-based antiretroviral therapy to tenofovir (TDF)-lamivudine-dolutegravir fixed-dose combination (TLD) in 2023. We aimed to evaluate changes in estimated glomerular filtration rate (eGFR) and predictors of rapid eGFR decline within 6 months during this programmatic dolutegravir (DTG) transition. This prospective observational study included all adult PLHIV (≥ 18 years old) who received an NVP-based regimen initially, had baseline eGFR of more than 60 mL/min/1.73m2 before the transition, and underwent the DTG transition program in Cipto Mangunkusumo Hospital from March 2023 to January 2024. Participants who did not have at least two eGFR measurements were not included in the study. The decline in the eGFR during the study period was defined by a minimum 25% eGFR decline from baseline, and multivariate regression was used for analysis. A total of 329 participants were transitioned to TLD. Of these patients, 242 (73.6%) transitioned from the zidovudine-lamivudine fixed-dose combination and NVP (AZT/3TC+NVP), and 87 (26.4%) transitioned from TDF+3TC+NVP. Within six months of observation, 87.2% of participants had eGFR decline. Sixty-one participants (18.5%) experienced rapid eGFR decline: 19.8% and 14.9% in those who had previously used AZT and TDF, respectively. Factors related to rapid eGFR decline were hypertension (aRR 1.87; 95% CI: 1.15 – 3.05) and longer usage of previous ART (aRR 1.05; 95% CI: 1.01 – 1.10). Rapid eGFR decline after transitioning from an NVP-based regimen to TLD warrants close monitoring, especially in patients with hypertension and longer use of ART.