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J Acquir Immune Defic Syndr. 2010 Jan;53(1):62-9. doi: 10.1097/QAI.0b013e3181be6be2.

Impact of tenofovir on renal function in HIV-infected, antiretroviral-naive patients.

Author information

1
HIV Initiative, Kaiser Permanente, 2000 Broadway Oakland, CA 94612, USA. michael.horberg@kp.org

Abstract

OBJECTIVE:

To better characterize the long-term effects of tenofovir on renal function in a large managed care organization.

METHODS:

We performed a retrospective cohort analysis in Kaiser Permanente for years 2002 to 2005 comparing renal function among antiretroviral naïve patients initiating a tenofovir-containing regimen (964 patients) or tenofovir-sparing regimens (683 patients). We evaluated glomerular filtration rate (GFR, [Modification of Diet in Renal Disease equation]), serum creatinine, and the development of renal proximal tubular dysfunction. We report multivariable hazard ratios (HR, Cox modeling) and linear outcomes (repeated measures) with predictors retained if P < 0.10 (backward selection). Potential predictor variables included in multivariate models were age, sex, Black race, baseline laboratories (including CD4 count), history of diabetes mellitus, hypertension, malignancy, hepatitis, and concurrent medications.

RESULTS:

Overall, tenofovir-exposed patients had a larger relative decline in GFR through 104 weeks (-7.6 mL/min/1.73 m(2) relative to tenofovir-sparing, P < 0.001); the degree of the difference varied by baseline GFR, with the greatest effect seen in those patients with GFR greater than 80 mL/min/1.73 m(2). Tenofovir-exposed patients had greater development of proximal tubular dysfunction over time (at 52 wk: HR(adjusted) = 1.95 [P = 0.01] and at 104 wk: HR(adjusted) = 5.23 [P = 0.0004]) and had greater risk of medication discontinuation (HR(adjusted) = 1.21, P = 0.02), especially as renal function worsened. Viral control and CD4 count changes were similar between the two groups.

CONCLUSIONS:

Tenofovir is associated with greater effect on decline in renal function and a higher risk of proximal tubular dysfunction in antiretroviral naïve patients initiating antiretroviral therapy.

PMID:
19838127
DOI:
10.1097/QAI.0b013e3181be6be2
[Indexed for MEDLINE]

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