BackgroundTenofovir disoproxil fumarate (TDF) is relatively safe, although renal toxicity has been reported. In Nigeria, there is insufficient data on renal toxicity among patients on TDF. This study assesses TDF-associated tubular dysfunction among human immunodeficiency virus (HIV) patients at a hospital in Nigeria.MethodsIn this cohort study, 104 adult HIV patients were recruited with a simple random technique from the outpatient clinic. Biochemical indices of renal function were estimated from serum and urine at the 16th and 24th week after an initial assessment at baseline.ResultsThere were no significant differences in baseline proteinuria or glycosuria between TDF and non-TDF groups. Mean baseline urine and serum parameters did not differ significantly between the two groups (P > 0.05). In the TDF group, all urine parameters differed significantly between baseline and 24th week values (P < 0.001). After 16 weeks, mean urine phosphate and urine uric acid increased significantly (P < 0.05) by 2.97 mg/dL and 50.9 mg/dL, respectively, in the TDF group. The rise in mean urine glucose from baseline to the 24th week was more marked in the TDF than the non-TDF group (0.25 vs. 0.07 mmol/L). Higher mean differences in urine albumin were also recorded in the TDF group from baseline to the 24th week.ConclusionIndicators of tubular dysfunction were markedly higher among patients on the TDF-based treatment regimen. Biomarkers of tubular dysfunction could be useful for detecting pre-symptomatic nephrotoxicity before marked reduction of glomerular filtration rate in HIV patients on TDF.
Background/Objectives: WHO recommends that all HIV patients have antiretroviral therapy (ART), however, ART has side-effects. This study assessed nephrotoxicity and hepatotoxicity among HIV patients on Tenofovir (TDF)-based ART in a tertiary facility in Nigeria.Methods: This cohort study was conducted among TDF-exposed and non-exposed HIV patients. Urinary Neutrophil Gelatinase-Associated Lipocalin (NGAL) and Cystatin C (CC), as well as serum liver enzymes, lipid, and bilirubin levels, were estimated. Glomerular filtration rate was estimated using Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) Cystatin C formula.Results: Median values of CC and NGAL increased more rapidly among the TDF than the non-TDF group from the 16 th to 24 th week. TDF-group were almost three times as likely as non-TDF to have abnormal levels of CC at the 24 th and 16 th weeks; OR: 2.77 (1.17-6.56); OR: 2.56 (1.15 -5.66) respectively. Increased frequency of abnormal NGAL levels between visits did not differ across the two treatment groups, OR: 1.07 (0.51-6.67). The mean values of CC/creatinine ratio increased significantly between baseline and 16th week for both groups, however, the increase was significant only for the TDF group from 16 th to 24 th week (p=0.002). The pairwise mean increase in NGAL/creatinine ratio was significant only for the TDF group with at least one-fifth (20.6%, 24.2%) increase between visits. The prevalence chronic kidney disease among the TDF-group was twice as high as in others, (40.6% versus19.6%, p=0.019). Alkaline phosphatase and aspartate transaminase increased significantly between baseline, 16 th and 24 th weeks among the TDF group. Low-Density Lipoprotein at 24 weeks was higher among TDF group than the non-TDF (2.18 ± 0.41 and 1.44 ± 0.35 respectively; p<0.001). Conclusion:TDF-associated toxicity was more pronounced on the kidneys. Thus, patients on TDF require regular monitoring of their renal function.
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