Incidence Rate and Time to Occurrence of Renal Impairment and Chronic Kidney Disease among Thai HIV-infected Adults with Tenofovir Disoproxil Fumarate Use

Abstract

Background: Tenofovir disoproxil fumarate (TDF) is a major antiretroviral therapy for Thai human immunodeficiency virus (HIV) infected adults. TDF is associated with a decrease in renal function. There is limited data about the use of TDF with the incidence and time to renal impairment and chronic kidney disease (CKD) in Thai HIV-infected adults. Objectives: To study the association of TDF with the incidence rate and duration of renal impairment and CKD in Thai patients. Methods: A retrospective cohort study in Thai naïve HIV-infected adults was conducted to compare the incidence rate and time to renal impairment and CKD in TDF and non-TDF groups. The incidence rate was analyzed by person-time. Time to renal impairment and CKD were analyzed by Kaplan-Meier curves and log-rank tests. Results: A total of 1,400 patients were enrolled. The incidence rates of renal impairment in TDF and non-TDF groups were 27.66/1,000 and 5.54/1,000 person-years. The rate ratio was 4.99 (95% confidence interval [CI] 2.66–9.35). The incidence rates of CKD in both groups were not significantly different. Themean difference of eGFR between the TDF and non-TDF groups was 1.92 ml/min/1.73 m2 (p = 0.022). Time to onset of renal impairment between the TDF and non-TDF groups was found to differ by approximately 20 months. Conclusion: The incidence rate of renal impairment was about five times higher in the TDF group. A rapid decline of eGFR occurred in the first 2–3 years of treatment. Therefore, the renal function of HIV-infected patients should be monitored so that the severity of renal impairment could be evaluated and CKD could be prevented.

Tenofovir induced Fanconi syndrome in a middle age African female from Kenya, East Africa: Case report and brief literature review

“…This rapid decline of estimated GFR mostly occur in the first 2-3 years of treatment. 9 The prevalence of renal dysfunction induced by TDF is estimated at 5.6%, and the risk is increased with advanced age, low BMI, low baseline CD4 count, hypertension, and diabetes. 10 Severe nephrotoxicity to warrant discontinuation has been reported in 1% patients yearly.…”

“…Patients on TDF based regimen are at five times greater risk of developing chronic kidney disease in comparison to patients on a non‐TDF based regimen. This rapid decline of estimated GFR mostly occur in the first 2–3 years of treatment 9 . The prevalence of renal dysfunction induced by TDF is estimated at 5.6%, and the risk is increased with advanced age, low BMI, low baseline CD4 count, hypertension, and diabetes 10 .…”