Renal safety of tenofovir containing antiretroviral regimen in a Singapore cohort

Chua, Arlene; Llorin, Ryan; Lai, Kelvin; Cavailler, Philippe; Law, Hwa Lin

doi:10.1186/1742-6405-9-19

Cited by 13 publications

(13 citation statements)

References 20 publications

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“…A considerable number of patients had clinically meaningful, mild CKD, with no patients with moderate or severe CKD or kidney failure (≥stage 3) CKD in this 3-year follow-up study. Our CKD incidence of 2.2–12.4% was not low, compared with previous studies in Asian countries, despite a lack of consistency in definition and inclusion population 1331323334…”

Section: Discussioncontrasting

confidence: 83%

Change in Renal Function among HIV-Infected Koreans Receiving Tenofovir Disoproxil Fumarate-Backbone Antiretroviral Therapy: A 3-Year Follow-Up Study

Lee

et al. 2017

Yonsei Med J

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PurposeTenofovir disoproxil fumarate (TDF) is commonly prescribed as a fixed-dose, co-formulated antiretroviral drug for HIV-1 infection. The major concern of long-term TDF use is renal dysfunction. However, little is known about the long-term patterns of changes in renal function in HIV-infected Koreans receiving TDF.Materials and MethodsWe prospectively followed 50 HIV-infected Koreans, performing laboratory tests every 3 months during the first year and every 6 months for the next 2 years. Urine N-acetyl-β-D-glucosaminidase (NAG) and plasma cystatin-C were measured using samples collected in the first year. Data on renal function were retrospectively collected on HIV-infected patients receiving first-line TDF (n=40) and in antiretroviral therapy (ART)-naïve patients (n=24) for 3 years. Renal function was evaluated as estimated glomerular filtration rate (eGFR) from serum creatinine [Modification of Diet in Renal Disease (MDRD)] and cystatin-C.ResultsThe eGFR (cystatin-C) showed significant changes from 0 to 48 wks (p=0.002), with the lowest levels at 24 wks (84.3±18.8 mL/min vs. 90.3±22.5 mL/min, p=0.021 by post hoc test). Urine NAG levels did not differ at 0, 12, 24, and 48 wks, although eGFR (MDRD) significantly decreased from 0 (98.7±18.9 mL/min/1.73 m2) to 144 wks (89.0±14.7 mL/min/1.73 m2) (p=0.010). The first-line TDF group had significantly lower eGFR (MDRD) than the ART-naïve group at 144 wks (89.7 mL/min/1.73 m2 vs. 98.4 mL/min/1.73 m2, p=0.036). Thirteen (26%) participants experienced a decrease in renal impairment of 10 mL/min/1.73 m2 in eGFR (MDRD) at 144 wks.ConclusionThese data suggest that clinically meaningful renal injury can develop in HIV-infected Koreans receiving long-term TDF.

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Section: Discussioncontrasting

confidence: 83%

Change in Renal Function among HIV-Infected Koreans Receiving Tenofovir Disoproxil Fumarate-Backbone Antiretroviral Therapy: A 3-Year Follow-Up Study

Lee

et al. 2017

Yonsei Med J

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“…Factors associated with the incidence of renal impairment were older age, baseline CD4, WHO HIV stages III and IV. The Incidence of renal impairment after initiation of TDF based regimens is varied across studies [3][4][5][6], but tended to be lower than the incidences observed in this study. This could be due to different study method approaches used and/or varying renal impairment incidences in different populations.…”

Section: Discussioncontrasting

confidence: 66%

Tenofovir Associated Renal Toxicity in a Cohort of Hiv Infected Individuals in Goa

Patel

Kumar

Talaulikar

2020

IJAR

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OBJECTIVE: Tenofovir disoproxil fumarate (TDF) is a nucleotide analogue recommended in international HIV treatment guidelines. Purpose of this study was to estimate the long term effects of TDF on renal prole in a cohort of HIV patients in Goa. Three hundred and fty four (354) consecutive HIV-positive patients who initiated TDF-based antiretroviral treatment from Jan 2016 to Dec 2018 at the Goa Medical College were sampled. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault equation at baseline and renal impairment was dened as CrCl values of 30.0–49.9 mL/min (moderate renal impairment) and < 25 mL/min (severe renal impairment) as per institutional guidelines for renal function test. RESULTS: Follow up time was 2 years. At study endpoint, 36 participants (10.2%) recorded CrCl rate below 50 mL/min indicating incident renal impairment, made up of 8.47% moderate renal impairment and 1.7% severe renal impairment. Factors associated with incidence of renal impairment were increasing age, WHO HIV stage III/IV and baseline low CD4 count. Patients with identied renal impairment risk factors at ART initiation should be targeted and monitored effectively to prevent renal injury.

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“…Just over six percent of these patients developed renal dysfunction during follow up, which is similar to recent studies done in Asia [ 12 , 13 ], but in the majority of these patients this was not severe enough to warrant a change in therapy. Only four patients (0.3%) progressed to severe renal dysfunction needing a change to an alternative ART regimen, with these findings mirroring those from elsewhere[ 14 ].These overall results are in line with previous studies which concluded that the clinical magnitude of renal toxicity during TDF-based ART is modest[ 6 ].This low incidence of renal toxicity is further confirmed by more recent publications from Africa and Asia [ 15 , 16 ]although differences in definitions of renal dysfunction and duration on TDF-based ART make it difficult to compare findings from one study to another.…”

Section: Discussionmentioning

confidence: 58%

Low Incidence of Renal Dysfunction among HIV-Infected Patients on a Tenofovir-Based First Line Antiretroviral Treatment Regimen in Myanmar

et al. 2015

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BackgroundSince 2004, Médecins Sans Frontières-Switzerland has provided treatment and care for people living with HIV in Dawei, Myanmar. Renal function is routinely monitored in patients on tenofovir (TDF)-based antiretroviral treatment (ART), and this provides an opportunity to measure incidence and risk factors for renal dysfunction.MethodsWe used routinely collected program data on all patients aged ≥15 years starting first-line TDF-based ART between January 2012 and December 2013. Creatinine clearance (CrCl) was assessed at base line and six-monthly, with renal dysfunction defined as CrCl < 50ml/min/1.73m2. We calculated incidence of renal dysfunction and used Cox regression analysis to identify associated risk factors.ResultsThere were 1391 patients, of whom 1372 had normal renal function at baseline. Of these, 86 (6.3%) developed renal dysfunction during a median time of follow-up 1.14 years with an incidence rate of 5.4 per 100 person-years: 78 had CrCl between 30–50ml/min/1.73m2 and were maintained on TDF–based ART, but 5 were changed to another regimen: 4 because of CrCl <30ml/min/1.73m2. Risk factors for renal dysfunction included age ≥45 years, diagnosed diabetes, underlying renal disease, underweight and CD4 count <200cells/mm3. There were 19 patients with baseline renal dysfunction and all continued on TDF-based ART: CrCl stayed between 30–49 ml/min/1.73m2 in five patients while the remainder regained normal renal function.ConclusionsIn a resource-poor country like Myanmar, the low incidence of renal toxicity in our patient cohort suggests that routine assessment of CrCl may not be needed and could be targeted to high risk groups if resources permit.

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Renal safety of tenofovir containing antiretroviral regimen in a Singapore cohort

Abstract: Background: Tenofovirdisoproxilfumarate (TDF) is a nucleotide analogue widely recommended in international HIV treatment guidelines. The association of TDF and renal dysfunction has remained an area of interest.

Cited by 13 publications

References 20 publications

Change in Renal Function among HIV-Infected Koreans Receiving Tenofovir Disoproxil Fumarate-Backbone Antiretroviral Therapy: A 3-Year Follow-Up Study

Change in Renal Function among HIV-Infected Koreans Receiving Tenofovir Disoproxil Fumarate-Backbone Antiretroviral Therapy: A 3-Year Follow-Up Study

Tenofovir Associated Renal Toxicity in a Cohort of Hiv Infected Individuals in Goa

Low Incidence of Renal Dysfunction among HIV-Infected Patients on a Tenofovir-Based First Line Antiretroviral Treatment Regimen in Myanmar

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