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

Publication

Author(s):

Tanuma J1, Jiamsakul A2, Makane A3, Avihingsanon A4, Ng OT5, Kiertiburanakul S6, Chaiwarith R7, Kumarasamy N8, Nguyen KV9, Pham TT10, Lee MP11, Ditangco R12, Merati TP13, Choi JY14, Wong WW15, Kamarulzaman A16, Yunihastuti E17, Sim BL18, Ratanasuwan W19, Kantipong P20, Zhang F21, Mustafa M22, Saphonn V23, Pujari S3, Sohn AH24; TREAT Asia HIV Observational Databases (TAHOD).

Pub Title:

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

Pub Date:

Aug 1 2016

Pub Region(s):

Asia-Pacific

Journal:

Title: 
PLoS One.

PubMed: 27560968
Pub PDF:

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.

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Citation:

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. Tanuma J1, Jiamsakul A2, Makane A3, Avihingsanon A4, Ng OT5, Kiertiburanakul S6, Chaiwarith R7, Kumarasamy N8, Nguyen KV9, Pham TT10, Lee MP11, Ditangco R12, Merati TP13, Choi JY14, Wong WW15, Kamarulzaman A16, Yunihastuti E17, Sim BL18, Ratanasuwan W19, Kantipong P20, Zhang F21, Mustafa M22, Saphonn V23, Pujari S3, Sohn AH24; TREAT Asia HIV Observational Databases (TAHOD).