Tenofovir Switch — SCE Infectious Diseases MCQ

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EasyHIV MedicineTenofovir SwitchSCE Infectious Diseases

A 50-year-old man with HIV on ART (CD4 400, VL <50) develops chronic kidney disease stage 3b (eGFR 38 mL/min). He is on Tenofovir Disoproxil/Emtricitabine/Efavirenz. His clinician plans to switch Tenofovir DF. Which NRTI substitution is most appropriate?

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Correct answer: C — Tenofovir Alafenamide (TAF) — less nephrotoxic prodrug delivering lower plasma tenofovir levels

TAF is a prodrug of Tenofovir that achieves high intracellular concentrations in lymphoid tissue with 90% lower plasma Tenofovir levels compared to TDF. This translates to significantly less renal (and bone) toxicity. For a patient with TDF-associated nephrotoxicity, switching to TAF is the preferred strategy, preserving the Tenofovir backbone activity. Abacavir is an alternative (requires negative HLA-B*5701 and has cardiovascular risk considerations per BHIVA 2025). The Efavirenz should also be reviewed given CNS side effects and current BHIVA preference for INSTIs.

Reference: BHIVA 2025 – ART guidelines; NICE CKS 2024 – CKD