Tenofovir Use and Renal Insufficiency among Pregnant and General Adult Population of HIV-infected, ART-Naïve Individuals in Lilongwe, Malawi

Johnson, Derek C.; Chasela, Charles; Maliwichi, Madalitso; Mwafongo, Albert; Akinkuotu, Adesola C.; Moses, Agness; Jamieson, Denise J.; Kourtis, Athena P.; King, Caroline C.; Horst, C. Van Der; Hosseinipour, Mina C.

doi:10.1371/journal.pone.0041011

Cited by 11 publications

(12 citation statements)

References 24 publications

(23 reference statements)

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“…This analysis documents risk factors for prevalent renal dysfunction in patients initiating ART that are similar to those identified by previous studies from sub-Saharan Africa including low haemoglobin or anaemia (Mulenga et al 2008;Johnson et al 2012), older age and lower CD4 cell counts before ART initiation (Franey et al 2009;Bygrave et al 2011). Although we found that women had higher relative odds of renal impairment at baseline, women also showed greater improvement in renal function over time.…”

Section: Discussionsupporting

confidence: 68%

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Renal impairment in HIV‐infected patients initiating tenofovir‐containing antiretroviral therapy regimens in a Primary Healthcare Setting in South Africa

Kamkuemah

Kaplan

Bekker

et al. 2014

Tropical Med Int Health

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Abstractobjective Long-term use of tenofovir disoproxil fumarate is associated with declines in glomerular function and chronic kidney disease in HIV-infected patients. We aimed to assess the prevalence and incidence of renal impairment in a primary care setting in sub-Saharan Africa.methods We analysed data from 1092 HIV-infected patients initiating tenofovir at a primary care clinic in Cape Town, South Africa. Renal function was assessed for the first 12 months on ART by estimating glomerular filtration rate (eGFR) calculated using the Cockroft-Gault equation categorised into normal, mild, moderate and severe reduction in renal function based on values >90, 60-89, 30-59 and <30 ml/min/1.73 m 2 , respectively. Associations were assessed using logistic regression, and average GFR trajectory over time was modelled using linear mixed-effects models.results The cohort consisted of 62% women; median age was 34 years (IQR 29; 41 years). The majority had normal renal function pre-ART (79%), 19% had mildly reduced GFR, and 2% had moderate renal impairment. Older age, more advanced WHO stage and anaemia were independently associated with prevalent renal impairment. On average, estimated glomerular function improved over the first year on tenofovir [1.10 ml/min/1.73 m 2 average increase over 12 months (95% CI: 0.80; 1.40)]. Male gender, anaemia and immunosuppression (WHO Stage III/IV and CD4 cell counts <100 cells/mm 3 ) were associated with lower average eGFR levels over time. Overall, 3% developed eGFR <50 ml/min/1.73 m 2 during this period. Serum creatinine tests conducted before 4 months on ART had low predictive value for predicting change in eGFR after a year on ART.conclusion Generally, renal function improved in HIV-infected adults initiating ART in this primary healthcare setting during the first year on ART. While monitoring of renal function is recommended in the first 4 months on ART, renal impairment appears uncommon during the first 12 months of tenofovir-containing ART in primary care populations.

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Section: Discussionsupporting

confidence: 68%

“…; Johnson et al . ), older age and lower CD4 cell counts before ART initiation (Franey et al . ; Bygrave et al .…”

Section: Discussionmentioning

confidence: 99%

Renal impairment in HIV‐infected patients initiating tenofovir‐containing antiretroviral therapy regimens in a Primary Healthcare Setting in South Africa

Kamkuemah

Kaplan

Bekker

et al. 2014

Tropical Med Int Health

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“…; Johnson et al . ). This phenomenon is explained in part by the haemodilution of pregnancy, resulting in lower absolute CD4 cell counts per microlitre in pregnant women relative to non‐pregnant adults at a similar stage of clinical disease progression (Gelson et al .…”

Section: Discussionmentioning

confidence: 97%

“…In turn, these data suggest that the risks of acute nephrotoxicity associated with immediate tenofovir initiation without prior screening of serum creatinine results appears minimal, in keeping with other data from primary care populations in Africa (Johnson et al . ). Other putative risks related to rapid ART initiation in pregnant women, including limited time for patient education and counselling prior to ART initiation, have not been demonstrated to adversely affect patient outcomes (Myer et al .…”

Section: Discussionmentioning

confidence: 97%

Low prevalence of renal dysfunction in HIV‐infected pregnant women: implications for guidelines for the prevention of mother‐to‐child transmission of HIV

Myer

Kamkuemah

Kaplan

et al. 2013

Tropical Med Int Health

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Abstractobjective Emerging international guidelines for the prevention of mother-to-child transmission of HIV infection across sub-Saharan Africa call for the initiation of a triple-drug antiretroviral regimen containing tenofovir, a potentially nephrotoxic agent, in all HIV-infected pregnant women at the first antenatal clinic visit. While there are significant benefits to the rapid initiation of antiretroviral therapy (ART) in pregnancy, there are few data on the prevalence of pre-existing renal disease in HIV-infected pregnant women and in turn, the potential risks of this approach are not well understood.methods We analysed data on renal function in consecutive patients eligible for ART at a large primary healthcare clinic in Cape Town. All individuals were screened for renal dysfunction via serum creatinine and estimation of creatinine clearance via the Cockroft-Gault equation.results Over a 2-year period, 238 pregnant women, 1014 non-pregnant women and 609 men were screened to initiate ART. Pregnant women eligible were significantly younger, in earlier stages of HIV disease, had higher CD4 cell counts and lower HIV viral loads, than non-pregnant adults. The median serum creatinine in pregnant women (46 mmol/L) was significantly lower and the median creatinine clearance (163 ml/min/1.73 m 2 ) was significantly higher than other groups (P < 0.001 and P = 0.004, respectively). Fewer than 1% of pregnant women had moderate renal dysfunction before ART initiation, with no instances of severe dysfunction observed, compared to 7% moderate or severe renal dysfunction in non-pregnant women or men (P < 0.001).conclusion Renal dysfunction in HIV-infected pregnant women is significantly less common than in other HIV-infected adults eligible for ART. The risks associated with initiating tenofovir immediately in pregnant women before reviewing serum creatinine results may be limited, and the benefits of rapid ART initiation in pregnancy may outweigh possible risks of nephrotoxicity.

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“…Tenofovir inclusion in highly active antiretroviral therapy regimens in the treatment of Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) has clinically shown to have an excellent efficacy and safety outcomes when compared with HAART regimens containing other first-line antiretroviral drugs, such as abacavir (ABC), stavudine (d4T) and zidovudine (AZT) [1,2]. Although TDF use has been associated with acceptable safety, several studies have reported a rare manifestation of renal disease in HAART regimens that include TDF [3][4][5][6][7][8].…”

Section: Social Valuementioning

confidence: 99%

Clinical Outcomes and Renal Safety in HIV/AIDS Patients on Tenofovir-containing Regimens in Lesotho

Sello¹,

Rakumakoe²,

Lubbe³

et al. 2019

JFMHC

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Although TDF use has been associated with acceptable safety, reports of rare manifestation of renal disease in HAART regimens that include TDF have been documented. The study was conducted at Paballong HIV/AIDS care centre in Berea, Lesotho. The aim of the study was to evaluate clinical outcomes and renal safety in HIV/AIDS patients taking TDFcontaining HAART regimens. Descriptive, observational, longitudinal retrospective design was followed on 255 adults on TDF-containing HAART regimens at the study area; from October 2015 to March 2016. Data captured on a data collection tool included baseline, follow-up and end-line characteristics of clinical outcomes and renal safety. Patients gained an estimated body weight of to 0.10 kg from baseline (p < 0.05) at any age. Females were on average 2.49 kg heavier than males (p < 0.05). The CD4 cell count results estimated a daily increase of 0.20 cells/mm 3 at any age. The mean CD4 cell count of female patients was 69.13 cells/mm 3 higher than for males (p = 0.02). The eGFR results contended that sex, age and body weight are risk factors to developing renal insufficiency. The eGFR declined by 0.78 ml/min/1.73m 2 over the treatment duration at any age of treatment initiation (p < 0.05), while the average eGFR for females was lower (13.05 ml/min) (p < 0.05). Clinical outcomes manifesting by weight gain and CD4 cell count elevation improve at any age and better in females. The renal function is progressively deteriorated at any age and worsened in females.

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Tenofovir Use and Renal Insufficiency among Pregnant and General Adult Population of HIV-infected, ART-Naïve Individuals in Lilongwe, Malawi

Cited by 11 publications

References 24 publications

Renal impairment in HIV‐infected patients initiating tenofovir‐containing antiretroviral therapy regimens in a Primary Healthcare Setting in South Africa

Renal impairment in HIV‐infected patients initiating tenofovir‐containing antiretroviral therapy regimens in a Primary Healthcare Setting in South Africa

Low prevalence of renal dysfunction in HIV‐infected pregnant women: implications for guidelines for the prevention of mother‐to‐child transmission of HIV

Clinical Outcomes and Renal Safety in HIV/AIDS Patients on Tenofovir-containing Regimens in Lesotho

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