Nephrotoxıcıty in Patıents on Tenofovır vs Non-Tenofovır Contaınıng Art Regımen: An Observatıonal Study

Abstract

Treatment of Human Immunodeficiency Virus (HIV) infection has been revolutionized by the newer generation of Anti-Retroviral therapy (ART). The first-line ART comprises of NRTI (Tenofovir plus Lamivudine) and one NNRT, Efavirenz. The renal tubular dysfunction associated with Tenofovir is an adverse effect of concern. This study was undertaken to find the incidence of nephrotoxicity due to Tenofovir based regimen in comparison to non TLE regimen. A nonrandomised cross-sectional study with 50 patients between 18-60 years already on ART regimen were included in each arm-TLE and non TLE. Nephrotoxicity was diagnosed if there was: 1) increase serum creatinine 2) Decrease Serum Uric Acid 3) abnormal spot urine albumin creatinine ratio 4) decrease blood haemoglobin concentration. Statistical analysis was done using Fischer's exact test. TLE and ZLN were the two most frequently prescribed regimen. Four patients [8% (p value 0.059)] developed nephrotoxicity in the TLE regimen as compared to none from the non-TLE regimen. Longer exposure to TLE regimen was a predisposing factor for nephrotoxicity as 3 patients were on tenofovir for more than 4 years but independent of age, body weight, or CD4 count. Anaemia was observed in 48% of patients on TLE vs 18% in non TLE regimen. 26% of patients on Tenofovir based regimen had an abnormality in at least one of the four parameters. Using Tenofovir alafenamide or shifting to an alternate regimen when early signs of renal injury are visible will prevent nephrotoxicity.

Tenofovir-Induced Renal Dysfunction Among HIV-Infected Patients: A Systematic Review

“…In contrast to other studies, Agrawal et al [ 18 ] found that patients who experienced nephrotoxicity were not underweight, and age was not a factor either, unlike in earlier studies where advanced age was an independent risk factor. They never discovered an association between the mean CD4 count of patients in both groups and the development of nephrotoxicity (500-1,500 cells/mm 3 ) because all the patients in both groups had below-normal CD4 counts.…”

“…14.3% of the 27% of proteinuria patients who had renal impairment also had proteinuria. However, the prevalence of glycosuria at the end of six months remained constant with the baseline frequency Renal impairment was identified in one-fourth of the individuals in this trial, raising concerns about the long-term use of TDF Agrawal et al 2022 [18] Serum creatinine levels at baseline and during the study period indicated a positive correlation (0.233) with a significant correlation and dependence (0.020) for all 100 patients when comparing the TLE with the non-TLE-based regimens. Baseline serum creatinine and at the time of the study were somewhat correlated (0.574) for the TLE regimen, and the association was both significant (0.000) and dependent (0.001).…”