Effect of Baseline Renal Function on Tenofovir-Containing Antiretroviral Therapy Outcomes in Zambia

Abstract

TDF use did not attenuate renal function recovery or increase the mortality rate in patients with renal dysfunction. Further studies are needed to determine the role of routine renal function monitoring before and during ART use in Africa.

Incidence, aetiology and outcome of community-acquired acute kidney injury in medical admissions in Malawi

“…HIV may increase the risk of AKI through direct renal injury, through ART nephrotoxicity, and through susceptibility to acute infective illness. Routine measurement of renal function pre or post initiation of TDF ART (first-line in adults) is not recommended in Malawi despite the potential nephrotoxic effects of TDF [18], which may delay diagnosis of AKI in this cohort. Importantly, AKI in Malawi is occurring in patients that are young with limited comorbidity outside HIV.…”

Incidence of stage 3 chronic kidney disease and progression on tenofovir-based regimens

“…Less than a handful of such studies have been conducted in sub-Saharan Africa, where the HIV disease burden is highest, more women are HIV-positive, treatment is initiated when the disease is more advanced, and resources are limited [18–20]. Furthermore, there are sketchy data on the incidence and predictors of kidney failure in patients receiving TDF-containing regimens in a “real world” clinical setting in sub-Saharan Africa [21–23]. Given the prevalence of genetic susceptibility traits that place individuals of African descent at risk of kidney disease [24], especially HIV-associated nephropathy (HIVAN) [25], more research is needed regarding the impact of TDF on kidney function; this information is crucial to guide clinicians, especially in view of the limited access to dialysis should patients develop kidney failure.…”

Long-term comparative and prospective cohort study of renal function in patients with HIV infection treated with tenofovir disoproxil fumarate

“…While most previously published works with shorter follow-up periods have found little variation of the eGFR related to TDF use [6], some observational studies with longer follow-up periods have found CRDRF related with TDF use [13][14][15][16][17]. It is worth mentioning some considerations about these studies.…”

“…It is worth mentioning some considerations about these studies. Some of them have been conducted in specific populations such as African population [16], among patients with low body weight [15], or treatment-naïve patients [17], and others have used the Cockcroft-Gault equation to estimate the creatinine clearance [13], which can result in an overestimate of the creatinine clearance. These situations might explain why our study shows a higher incidence of chronic kidney disease related to TDF use in the long term.…”

“…Moreover, large clinical trials with long follow-up periods of more than 144 weeks in naïve patients have shown a renal safety profile of ART containing TDF, either similar to other ART without it, or with small significant declines in the estimated glomerular filtration rate (eGFR) of clinical implications difficult to ascertain [7][8][9]. Observational studies with longer follow-up periods suggest a more deleterious effect on the renal function, and point that TDF is associated with a higher incidence of chronic kidney disease [10][11][12][13][14][15][16][17]. Overall, these results have shown either a modest or absent decline in renal function associated with TDF use after short follow-up periods of months or very few years, while studies with longer follow-up periods suggest a more relevant decrease in renal function [13][14][15][16][17].…”