Kidney dysfunction associated with tenofovir exposure in human immunodeficiency virus-1-infected Taiwanese patients
Journal
Journal of Microbiology, Immunology and Infection
Journal Volume
50
Journal Issue
5
Pages
595-603
Date Issued
2017
Author(s)
Tsai M.-S.
Lee K.-Y.
Abstract
Background/Purpose Tenofovir disoproxil fumarate (TDF) is associated with kidney tubular dysfunction, for which the risk may vary among patients of different ethnicities. Data are limited, however, on the association between renal function changes and TDF exposure in human immunodeficiency virus (HIV)-infected Taiwanese patients. Methods Medical records of HIV-infected Taiwanese patients seeking HIV care at a university hospital from 2011 to 2014 were reviewed. The change of estimated glomerular filtration rate (eGFR) was compared between patients not receiving combination antiretroviral therapy (cART) and those starting cART with or without TDF. The determinants of annual eGFR changes and factors associated with greater annual eGFR decline in TDF-exposed patients were explored. Results A total of 775 patients were included: 140 were cART-na?ve, 393 received TDF-containing cART, and 242 received cART without TDF. Compared with cART-na?ve patients, the annual eGFR decline was greater in TDF-exposed patients (0.57 ± 8.6 mL/min/1.73 m2 and 2.7 ± 8.9 mL/min/1.73 m2, p = 0.012). The annual eGFR decline between patients receiving cART with or without TDF was similar (2.7 ± 8.9 mL/min/1.73 m2 and 1.8 ± 8.3 mL/min/1.73 m2, p = 0.567). Diabetes was associated with worsening eGFR decline in all studied patients. TDF exposure correlated with an additional annual eGFR decline of 2.73 mL/min/1.73 m2 (95% confidence interval 0.139–5.326, p = 0.039) in patients with CD4 count < 350 cells/μL. Among TDF-exposed patients, the factors associated with annual eGFR decline of > 3 mL/min/1.73 m2 were higher baseline eGFR and lower CD4 counts. Conclusion Among HIV-infected Taiwanese patients, cART exposure correlated with the decline of renal function. However, TDF-exposed patients are more likely to have prominent eGFR decline, especially those with higher baseline eGFR, advanced HIV disease, and diabetes. ? 2015
SDGs
Other Subjects
antiretrovirus agent; efavirenz; lamivudine; lopinavir plus ritonavir; nevirapine; raltegravir; tenofovir disoproxil; anti human immunodeficiency virus agent; Human immunodeficiency virus proteinase inhibitor; tenofovir; adult; aged; antiretroviral therapy; Article; CD4 lymphocyte count; cohort analysis; confidence interval; controlled study; diabetes mellitus; drug exposure; drug withdrawal; estimated glomerular filtration rate; female; human; Human immunodeficiency virus 1 infection; Human immunodeficiency virus infected patient; kidney dysfunction; kidney function; major clinical study; male; medical record review; middle aged; patient care; retrospective study; Taiwanese; treatment outcome; university hospital; chemically induced; combination drug therapy; complication; drug effect; glomerulus filtration rate; Human immunodeficiency virus 1; Human immunodeficiency virus infection; kidney failure; Taiwan; young adult; Adult; Anti-HIV Agents; CD4 Lymphocyte Count; Drug Therapy, Combination; Female; Glomerular Filtration Rate; HIV Infections; HIV Protease Inhibitors; HIV-1; Humans; Male; Middle Aged; Renal Insufficiency; Retrospective Studies; Taiwan; Tenofovir; Young Adult
Type
journal article