PLoS ONE (Jan 2016)

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

  • Junko Tanuma,
  • Awachana Jiamsakul,
  • Abhimanyu Makane,
  • Anchalee Avihingsanon,
  • Oon Tek Ng,
  • Sasisopin Kiertiburanakul,
  • Romanee Chaiwarith,
  • Nagalingeswaran Kumarasamy,
  • Kinh Van Nguyen,
  • Thuy Thanh Pham,
  • Man Po Lee,
  • Rossana Ditangco,
  • Tuti Parwati Merati,
  • Jun Yong Choi,
  • Wing Wai Wong,
  • Adeeba Kamarulzaman,
  • Evy Yunihastuti,
  • Benedict Lh Sim,
  • Winai Ratanasuwan,
  • Pacharee Kantipong,
  • Fujie Zhang,
  • Mahiran Mustafa,
  • Vonthanak Saphonn,
  • Sanjay Pujari,
  • Annette H Sohn,
  • TREAT Asia HIV Observational Databases (TAHOD)

DOI
https://doi.org/10.1371/journal.pone.0161562
Journal volume & issue
Vol. 11, no. 8
p. e0161562

Abstract

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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 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 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.