Impact of a tenofovir disoproxil fumarate plus ritonavir-boosted protease inhibitor-based regimen on renal function in HIV-infected individuals: a prospective, multicenter study

Abstract

BackgroundThe aim of this study was to investigate the impact of a tenofovir disoproxil fumarate (TDF) plus ritonavir-boosted protease inhibitor (PI/r) regimen on renal function in Chinese HIV-infected patients.MethodsSeventy-five HIV-1 infected patients failing first-line antiretroviral therapy (ART) comprised the TDF+PI/r group. Seventy-five HIV-1 infected patients matched for gender, age, and renal function made up the control. All subjects completed follow-up visits over 48 weeks. CD4 cell count, plasma HIV-1 viral load, and urine protein level were assessed at the trial start (baseline, week 0) and at week 48. The serum creatinine and estimated glomerular filtration rate (eGFR) were monitored at each follow-up point. Change in eGFR from baseline to week 48 was also compared.ResultsCompared to control, the TDF+PI/r group exhibited higher levels of serum creatinine (79 vs. 69.7 μmol/L, P<0.001) and a lower rate of eGFR (93.0 vs. 101.6 ml/min/1.73m2, P=0.009) at the end of week 48. Patients treated with TDF+PI/r showed greater decline in eGFR than control (−8.8 vs. 6.4ml/min/1.73m2, P<0.001). Compared to baseline renal function of the control group, the TDF+PI/r group exhibited a greater median decline in eGFR at the end of week 48 (P<0.001).ConclusionsWe found that a TDF+PI/r based ART regimen resulted in greater renal function decline over 48 weeks. Therefore, renal function should be monitored especially when TDF is used in combination with PI/r.Trial registrationClinicalTrials.gov identifier: NCT00872417

Lipid profile and renal safety of tenofovir disoproxil fumarate-based anti-retroviral therapy in HIV-infected Chinese patients

“…TDF-related renal dysfunction has been reported more frequently in Asian countries than in Western countries (Gervasoni et al, 1999;Lichtenstein et al, 2001;Noor et al, 2002). Two Chinese cohorts showed average annual decreases in eGFR of 2.7 mlÁmin À1 Á1.73 m À2 and 3.5 mlÁmin À1 Á1.73 m À2 in TDF-exposed patients, respectively (Huang et al, 2015b;Cao et al, 2013). However, a relatively faster decrease (4.2 mlÁmin À1 Á1.73 m À2 annually) in eGFR was observed in our study.…”

Effect of changing from first- to second-line antiretroviral therapy on renal function: a retrospective study based on data from a single health facility in Namibia

“…At the time of writing this paper, LPV/r is the only PI available for second-line cART in the public sector in Namibia, and is co-administered with TDF, 3TC and AZT [5]. Since TDF and LPV/r are associated with nephrotoxicity, their coadministration poses a higher risk for renal impairment [6,7]. It should be noted that the risk of renal impairment may be influenced by gender, because of the hormonal differences between males and females [8].…”

Increased bone resorption during tenofovir plus lopinavir/ritonavir therapy in Chinese individuals with HIV

“…Details of the recruitment and follow up of the original parent study have been described previously [30,31]. All participants enrolled in the parent trial had clinical and laboratory evaluations performed at week 0, 4, 12, and every 12 weeks thereafter.…”