PAMJ Clinical Medicine (Jun 2020)

Incidence and association of renal dysfunction with a long term Tenofovir-based therapy among HIV-positive naïve cohort at Ronald Ross Hospital

  • Enock Wantakisha,
  • Derick Munkonbwe,
  • Tshula Tumba,
  • Charles Michelo

DOI
https://doi.org/10.11604/pamj-cm.2020.3.48.21115
Journal volume & issue
Vol. 3, no. 48

Abstract

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Introduction: Tenofovir-based antiretroviral therapy places HIV-infected patients at high risk of renal dysfunction. Therefore, we evaluated if the incidence of renal dysfunction in adults HIV positive patients with long term tenofovir-based regimen use is higher than in those without Tenofovir use.Methods: we performed a retrospective cohort analysis of 834 HIV positive patients at the counselling and testing center at Ronald Ross General Hospital. Patients´ records in data management software called SMARTCARE from 2008 to 2012 were reviewed to compare renal function between patients on tenofovir-containing regimen (447) with non-Tenofovir containing regimen (387). We evaluated glomerular filtration rate using creatinine clearance, serum creatinine, urea and exposure to TB medication, Cotrimoxazole use and CD4 cell count. Multivariable logistic regression was used to determine the factors associated with renal dysfunction. We report multivariable hazard ratios, risk ratios and linear outcomes with predictors retained if P less than 0.05. Potential predictor variables included in the multivariable models were age, sex, weight, serum creatinine and treatment with tenofovir.Results: the CD4 cell count, urea, anti-TB medication, Co-trimoxazole use, education level, employment status and creatinine clearance were similar at baseline between the two groups. Tenofovir-exposed patients had a relative increase in serum creatinine (P less than 0.04) and decline in creatinine clearance at 18 months during treatment (P less than 0.16)) relative to non-tenofovir exposed patients; Tenofovir exposed patients had a risk of developing renal dysfunction more than the non-tenofovir-exposed group (OR: 4.5, 95% CI, -1.71-10.7, P less than 0.032). Further, serum creatinine μmol/L increase (OR: 0.1, 95% CI, -0.43-(-0.40, p less than 0.02)), age per year-increase (OR: 0.75, 95% CI -1.28-(-0.34), P less than 0.01), body weight per 1 kg-increase (OR: 0.65, 95% CI, 0.015-1.07, P less than 0.04) and gender are risk factors to renal dysfunction.Conclusion: tenofovir-based therapy is associated with decline in renal function, with most developing mild renal dysfunction. The need for close renal monitoring of patients initiated on tenofovir by using creatinine clearance is recommended and use of less renal toxic Tenofovir-Alafenamide (TAF) analogue.

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