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, P. KantipongF. J. Zhang, Mahiran Mustafa, V. Saphonn, Sanjay Pujari, Annette H. Sohn, TREAT Asia HIV Observational Databases (TAHOD)

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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 <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.

Original languageEnglish
Article numbere0161562
Number of pages14
JournalPLoS ONE
Issue number8
Publication statusPublished - 25 Aug 2016
Externally publishedYes

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