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PLoS One. 2016 Aug 25;11(8):e0161562. doi: 10.1371/journal.pone.0161562. eCollection 2016.

Renal Dysfunction during Tenofovir Use in a Regional Cohort of HIV-Infected Individuals in the Asia-Pacific.

Author information

1
AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
2
The Kirby Institute, UNSW Australia, Sydney, Australia.
3
Institute of Infectious Diseases, Pune, India.
4
The Netherland Australia Thailand Research Collaboration/Thai Red Cross AIDS Research Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
5
Department of Infectious Disease and Communicable Disease Centre, Tan Tock Seng Hospital, Singapore, Singapore.
6
Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
7
Research Institute for Health Sciences, Chiang Mai, Thailand.
8
Chennai Antiviral Research and Treatment Clinical Research Site, Y.R. Gaitonde Centre for AIDS Research and Education, Chennai, India.
9
National Hospital of Tropical Diseases, Hanoi, Vietnam.
10
Infectious Disease Department, Bach Mai Hospital, Hanoi, Vietnam.
11
Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China.
12
Department of Health, Research Institute for Tropical Medicine, Manila, Philippines.
13
Faculty of Medicine, Udayana University & Sanglah Hospital, Bali, Indonesia.
14
Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
15
Infectious Diseases and AIDS Unit, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
16
Faculty of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia.
17
Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
18
Department of Medicine, Hospital Sungai Buloh, Sungai Buloh, Malaysia.
19
Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
20
Department of Medicine, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand.
21
Beijing Ditan Hospital, Capital Medical University, Beijing, China.
22
Medical Department, Hospital Raja Perempuan Zainab II, Kota Bharu, Malaysia.
23
National Center for HIV/AIDS, Dermatology & STDs, University of Health Sciences, Phnom Penh, Cambodia.
24
TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand.

Abstract

BACKGROUND:

In resource-limited settings, routine monitoring of renal function during antiretroviral therapy (ART) has not been recommended. However, concerns for tenofovir disoproxil fumarate (TDF)-related nephrotoxicity persist with increased use.

METHODS:

We investigated serum creatinine (S-Cr) monitoring rates before and during ART and the incidence and prevalence of renal dysfunction after starting TDF by using data from a regional cohort of HIV-infected individuals in the Asia-Pacific. Time to renal dysfunction was defined as time from TDF initiation to the decline in estimated glomerular filtration rate (eGFR) to <60 ml/min/1.73m2 with >30% reduction from baseline using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation or the decision to stop TDF for reported TDF-nephrotoxicity. Predictors of S-Cr monitoring rates were assessed by Poisson regression and risk factors for developing renal dysfunction were assessed by Cox regression.

RESULTS:

Among 2,425 patients who received TDF, S-Cr monitoring rates increased from 1.01 to 1.84 per person per year after starting TDF (incidence rate ratio 1.68, 95%CI 1.62-1.74, p <0.001). Renal dysfunction on TDF occurred in 103 patients over 5,368 person-years of TDF use (4.2%; incidence 1.75 per 100 person-years). Risk factors for developing renal dysfunction included older age (>50 vs. ≤30, hazard ratio [HR] 5.39, 95%CI 2.52-11.50, p <0.001; and using PI-based regimen (HR 1.93, 95%CI 1.22-3.07, p = 0.005). Having an eGFR prior to TDF (pre-TDF eGFR) of ≥60 ml/min/1.73m2 showed a protective effect (HR 0.38, 95%CI, 0.17-0.85, p = 0.018).

CONCLUSIONS:

Renal dysfunction on commencing TDF use was not common, however, older age, lower baseline eGFR and PI-based ART were associated with higher risk of renal dysfunction during TDF use in adult HIV-infected individuals in the Asia-Pacific region.

PMID:
27560968
PMCID:
PMC4999237
DOI:
10.1371/journal.pone.0161562
[Indexed for MEDLINE]
Free PMC Article

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