Higher risk of renal impairment associated with tenofovir use amongst people living with HIV in India: A comparative cohort analysis between Western India and United Kingdom

Pujari, Sanjay; Smith, Colette; Makane, Abhimanyu; Youle, Mike; Johnson, Margaret; Bele, Vivek; Joshi, Kedar; Dabhade, Digamber

doi:10.1186/1471-2334-14-173

Cited by 21 publications

(18 citation statements)

References 17 publications

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“…The majority of patients had normal renal function at baseline. 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: Discussionsupporting

confidence: 85%

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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Section: Discussionsupporting

confidence: 85%

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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“…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: 84%

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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“…Numerous reports have documented higher incidence of CKD in Asian PLHIV compared with European and US cohorts. In a study from India, PLHIV on a TDF‐based regimen had higher and faster decline in the eGFR compared with PLHIV in the United Kingdom . In a 12‐year observational cohort in Tokyo, incidence of CKD was 20.6 per 1000 years of follow‐up and was strongly associated with use of TDF .…”

Section: Discussionmentioning

confidence: 99%

“…In a study from India, PLHIV on a TDF-based regimen had higher and faster decline in the eGFR compared with PLHIV in the United Kingdom. 16 In a 12-year observational cohort in Tokyo, incidence of CKD was 20.6 per 1000 years of follow-up and was strongly associated with use of TDF. 4 Chronic kidney disease has been reported among 7.3% of Vietnamese PLHIV on ART.…”

Section: Numerous Reports Have Documented Higher Incidence Of Ckd Inmentioning

confidence: 99%

Changes in renal function with long‐term exposure to antiretroviral therapy in HIV‐infected adults in Asia

Joshi¹,

Boettiger

Kerr

et al. 2018

Pharmacoepidemiology and Drug

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Introduction: Renal disease is common amongst people living with HIV. However, there is limited information on the incidence and risk factors associated with renal dysfunction among this population in Asia. Methods: We used data from the TREAT Asia HIV Observational Database. Patients were included if they started antiretroviral therapy (ART) during or after 2003, had a serum creatinine measurement at ART initiation (baseline) and had at least two follow-up creatinine measurements taken ≥3 months apart. Patients with a baseline estimated glomerular filtration rate (eGFR) ≤60ml/min/1.73m2 were excluded. Chronic kidney disease was defined as two consecutive eGFR values ≤60ml/min/1.73m2 taken ≥3 months apart. Generalized estimating equations were used to identify factors associated with eGFR change. Competing risk regression adjusted for study site, age and sex, and cumulative_incidence plots were used to evaluate factors associated with CKD. Results: Of 2,547 patients eligible for this analysis, tenofovir was being used by 703 (27.6%) at baseline. Tenofovir use, high baseline eGFR, advanced HIV disease stage and low nadir CD4 were associated with a decrease in eGFR during follow up. CKD occurred at a rate of 3.4 per 1000 patient/years. Factors associated with CKD were tenofovir use, old age, low baseline eGFR, low nadir CD4, and protease inhibitor use. Conclusions: There is an urgent need to enhance renal monitoring and management capacity among at-risk groups in Asia and improve access to less nephrotoxic antiretrovirals.

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Higher risk of renal impairment associated with tenofovir use amongst people living with HIV in India: A comparative cohort analysis between Western India and United Kingdom

Cited by 21 publications

References 17 publications

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

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

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

Changes in renal function with long‐term exposure to antiretroviral therapy in HIV‐infected adults in Asia

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