Tenofovir-Related Nephropathies in HIV-Infected Patients

Lai, Silvia; Mariotti, Amalia; Lai, Carlo; Testorio, Massimo; Carta, Maria Paola; Innico, Georgie; Frassetti, Nicla; Mangiulli, Marco; D’Angelo, Annarita; Russo, Gaspare Elios

doi:10.2174/1570161112666141120131850

Cited by 3 publications

(3 citation statements)

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“…Recent studies evaluating this issue in real practice have a small sample size [13][14][15][16][17] and limited time of follow-up [13,17] so further studies are needed. The largest study included 235 patients, but time of follow-up was only 12 months [13].…”

Section: Haart and Renal Disordersmentioning

confidence: 99%

Incidence and risk factors for tenofovir-associated renal toxicity in HIV-infected patients

et al. 2015

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Section: Haart and Renal Disordersmentioning

confidence: 99%

Incidence and risk factors for tenofovir-associated renal toxicity in HIV-infected patients

et al. 2015

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“…It has been well-documented that among patients with human immunodeficiency virus (HIV) infection, adefovir (ADV), and TDF are associated with renal toxicity. [4][5][6] The nephrotoxicity of ADV was clearly seen in early studies in HIV patients, in which up to 12 times the current HBV dose were tested. Even at the approved HBV dose, ADV carries a "black box" warning for nephrotoxicity.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal trends in renal function in chronic hepatitis B patients receiving oral antiviral treatment

Udompap

Kim

Ahmed

et al. 2018

Aliment Pharmacol Ther

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Summary Background Long term renal safety of antiviral agents against hepatitis B virus (HBV) has been debated. Aim To compare longitudinal trends of renal function among HBV mono‐infected patients receiving entecavir (ETV), tenofovir disoproxil fumarate (TDF), and adefovir (ADV) in comparison to untreated subjects. Methods A retrospective cohort consisting of 815 patients with chronic HBV infection was constructed. Serial estimated glomerular filtration rate (eGFR) was compared to the expected rate of age‐dependent decline in eGFR, derived from the National Health and Nutrition Examination Survey (NHANES) data. Generalised estimating equations and linear mixed‐effects models were used to compare trends in eGFR (in mL/min/1.73m2 as a “unit”). Results In NHANES data (n = 23 051), each year of age was associated with a 0.86 unit decrease in eGFR in subjects without hypertension and 0.96 units with hypertension. The Stanford cohort consisted of patients who received ETV (n = 207), TDF (n = 191), ADV (n = 46) or no therapy (n = 371). After a median follow‐up 4.0 (interquartile range: 1.9‐6.5) years, there was no significant difference in the expected and observed rates of eGFR decline in untreated HBV patients. Patients receiving antiviral treatment experienced steeper reduction in renal function than expected. In the multivariable model, ETV was associated with eGFR loss at 1.81 units per year (P = 0.06, compared to untreated patients). TDF‐ and ADV‐treated patients experienced significantly higher rate of eGFR loss at 2.21 and 2.63 units per year, respectively (both P < 0.01). Conclusion In this longitudinal cohort study, HBV patients receiving antiviral therapy, particularly TDF and ADV, experienced more rapid loss in eGFR.

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“…Therefore, the lower rate of nephrotoxicity observed in our study may be attributed to the shorter follow-up time compared to other studies. In a study by Lai et al [21] including 27 patients using TDF, 81% exhibited phosphaturia, glycosuria, and bicarbonaturia as findings of proximal tubular damage, and this damage was largely reversible in 70% of cases. Although we observed significant differences between the PI and INSTI groups in terms of maximum creatinine levels during ART, they were not interpreted as significant since baseline eGFR and creatinine levels and treatment durations differed between the groups.…”

Section: Discussionmentioning

confidence: 98%

Evaluation of the Side Effects of Antiretroviral Treatment

Başgönül¹,

Gençer²,

Özer³

2018

mjima

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The frequency of antiretroviral therapy (ART)-induced side effects varies in HIV-infected patients. In this study, we aimed to compare drug-induced side effects developing in patients receiving different ART regimens. Materials and Methods: This study was performed after obtaining approval of İstanbul Kartal Dr. Lütfi Kırdar Training and Research Hospital's Ethics Committee (89513307/1009/515) on 30.12.2015. Ninety-five patients with HIV infection followed-up between January 2012 and December 2015 who received ART were included in this study. Their clinical and laboratory findings were evaluated retrospectively and possible drug-related side effects were investigated. Antiretroviral therapy regimens were compared using chi-square test and Fisher's exact test for categorical variables and with Mann-Whitney U test for numerical variables; changes in numerical variables were compared using Wilcoxon test. SPSS 22.0 software (Chicago, IL, USA) was used for data analyses. Results: All cases were treated with regimens consisting of tenofovir/emtricitabine (TDF/FTC). Three patients restarted treatment after quitting for several months, thus 98 regimens administered to 95 patients were evaluated. Forty-nine of them received protease inhibitors (PIs), 44 received integrase inhibitors (INSTIs), and five received non-nucleoside reverse transcriptase inhibitors. The median (IQR) follow-up period was seven (4-13) months. None of the patients had renal function abnormality before ART but during treatment three (3.1%) of them needed renal dose adjustment for TDF/FTC. Compared to baseline values, there were significant differences in creatinine and creatinine clearance levels during treatment (p<0.001). Hyperlipidemia developed in 50% of the patients who did not have hyperlipidemia at start of treatment and this rate differed significantly between the PI and INSTI regimens (69% and 26%, respectively, χ 2 =11.214, p=0.001). Seventeen percent of the patients developed an elevation in ALT levels during the treatment, but none required treatment change for this reason. Treatment changes were made 27 times in 21 patients while 15 of these changes were due to probable side effects. Thus, of 125 treatment regimens, possible clinical side effects were observed in 30 (24%), 13 of which were diarrhea. Gastrointestinal side effects were observed in 26% with PI-based regimens and neuropsychiatric side effects were observed in 6% with INSTI-based regimens. Conclusion: The most common side effects were hyperlipidemia (50%) and diarrhea (23%). Diarrhea was responsible for two-thirds of the ART switches in our study. It is important to monitor patients receiving ART for possible side effects. The results of longer and more comprehensive follow-up are needed to obtain more definitive data.

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Tenofovir-Related Nephropathies in HIV-Infected Patients

Cited by 3 publications

References 0 publications

Incidence and risk factors for tenofovir-associated renal toxicity in HIV-infected patients

Incidence and risk factors for tenofovir-associated renal toxicity in HIV-infected patients

Longitudinal trends in renal function in chronic hepatitis B patients receiving oral antiviral treatment

Evaluation of the Side Effects of Antiretroviral Treatment

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