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Pharmacoepidemiol Drug Saf. 2018 Nov;27(11):1209-1216. doi: 10.1002/pds.4657. Epub 2018 Sep 24.

Changes in renal function with long-term exposure to antiretroviral therapy in HIV-infected adults in Asia.

Author information

1
Institute of Infectious Diseases, Pune, India.
2
The Kirby Institute, UNSW, Sydney, NSW, Australia.
3
HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
4
National Center for Global Health and Medicine, Tokyo, Japan.
5
National Hospital for Tropical Diseases, Hanoi, Vietnam.
6
National Center for HIV/AIDS, Dermatology and STDs, Phnom Penh, Cambodia.
7
Queen Elizabeth Hospital, Hong Kong.
8
Chennai Antiviral Research and Treatment Clinical Research Site (CART CRS), YRGCARE Medical Centre, VHS, Chennai, India.
9
Taipei Veterans General Hospital, Taipei, Taiwan.
10
Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand.
11
Bach Mai Hospital, Hanoi, Vietnam.
12
University Malaya Medical Centre, Kuala Lumpur, Malaysia.
13
Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
14
Beijing Ditan Hospital, Capital Medical University, Beijing, China.
15
Research Institute for Health Sciences, Chiang Mai, Thailand.
16
Tan Tock Seng Hospital, Singapore.
17
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
18
Hospital Sungai Buloh, Sungai Buloh, Malaysia.
19
Faculty of Medicine, Udayana University and Sanglah Hospital, Denpasar, Indonesia.
20
Faculty of Medicine, Universitas Indonesia-Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
21
Research Institute for Tropical Medicine, Muntinlupa City, Philippines.
22
TREAT Asia, amfAR-The Foundation for AIDS Research, Bangkok, Thailand.

Abstract

PURPOSE:

Renal disease is common among people living with human immunodeficiency virus (HIV). However, there is limited information on the incidence and risk factors associated with renal dysfunction among this population in Asia.

METHODS:

We used data from the TREAT Asia HIV Observational Database. Patients were included if they started antiretroviral therapy during or after 2003, had a serum creatinine measurement at antiretroviral therapy initiation (baseline), and had at least 2 follow-up creatinine measurements taken ≥3 months apart. Patients with a baseline estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m2 were excluded. Chronic kidney disease was defined as 2 consecutive eGFR values ≤60 mL/min/1.73 m2 taken ≥3 months apart. Generalized estimating equations were used to identify factors associated with eGFR change. Competing risk regression adjusted for study site, age and sex, and cumulative incidence plots were used to evaluate factors associated with chronic kidney disease (CKD).

RESULTS:

Of 2547 patients eligible for this analysis, tenofovir was being used by 703 (27.6%) at baseline. Tenofovir use, high baseline eGFR, advanced HIV disease stage, and low nadir CD4 were associated with a decrease in eGFR during follow-up. Chronic kidney disease occurred at a rate of 3.4 per 1000 patient/years. Factors associated with CKD were tenofovir use, old age, low baseline eGFR, low nadir CD4, and protease inhibitor use.

CONCLUSIONS:

There is an urgent need to enhance renal monitoring and management capacity among at-risk groups in Asia and improve access to less nephrotoxic antiretrovirals.

KEYWORDS:

Asia; HIV AIDS; antiretroviral therapy; eGFR; pharmacoepidemiology; renal function; tenofovir (TDF)

PMID:
30246898
PMCID:
PMC6218305
[Available on 2019-11-01]
DOI:
10.1002/pds.4657

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