The effect of Tenofovir on renal function among Ugandan adults on long-term antiretroviral therapy: a cross-sectional enrolment analysis

Abstract

BackgroundWHO recommends using Tenofovir containing first line antiretroviral therapy (ART), however, Tenofovir has been reported to be associated with renal impairment and dysfunction. We compared renal function among individuals on Tenofovir and those on non-Tenofovir containing ART.MethodsIn a cross-sectional study of HIV-Positive adults on ART, at enrolment into a prospective cohort to study the long-term complications of ART in Uganda, information on biophysical measurements, medical history, clinical examination and renal function tests (RFTs) was collected. Fractional Tubular phosphate reabsorption and estimated glomerular filtration rate (eGFR) were calculated. Mean values of RFTs and proportions with abnormal RFTs were compared between non-Tenofovir containing (Non-TDF) and Tenofovir containing (TDF-ART) ART regimen groups using a general linear regression model. Durations of TDF exposure were also compared.ResultsBetween July 2013 and October 2014, we enrolled 953 individuals on ART for 6 or more months, median duration on ART was 9.3 years, 385 (40.4 %) were on non-TDF and 568 (59.6 %) on TDF-ART regimens. The proportion of participants with Proteinuria (>30 mg/dl) was higher among the TDF-ART group than the non-TDF ART group. However, in multivariable analysis, there were no significant differences in the adjusted mean differences of eGFR, serum urea, serum creatinine, fractional tubular reabsorption of phosphate and serum phosphates when patients on TDF-ART were compared with those on non-TDF containing ART. There were no differences in renal function even when different durations on Tenofovir were compared.ConclusionsWe found no differences in renal function among patients on Tenofovir and non-Tenofovir containing ART for almost a decade. Tenofovir based first line ART can therefore safely be initiated even in settings without routine renal function monitoring.

Lopinavir plus nucleoside reverse-transcriptase inhibitors, lopinavir plus raltegravir, or lopinavir monotherapy for second-line treatment of HIV (EARNEST): 144-week follow-up results from a randomised controlled trial

“…Although most patients who were on protease inhibitor plus NRTI received tenofovir-containing regimens and we used sparse renal toxicity monitoring (achievable in typical programme settings), few patients developed clinically significant renal toxicity. This finding is consistent with reports from similar African programme settings, 16 , 17 and shows that intensive renal monitoring is unnecessary in the public health approach in Africa, even in second-line therapy in which serum concentrations of tenofovir are boosted by concomitant protease inhibitor use. More data are needed in Asian patients in whom lower average bodyweight might further increase tenofovir concentrations.…”

Renal function in Ethiopian HIV-positive adults on antiretroviral treatment with and without tenofovir

“…Additionally, as opposed to TDF nephrotoxicity, the serum phosphate level was higher in TDF based regimen compared to non-TDF based regimen after 12 months of ART. Although larger retrospective cohort studies reported decline in kidney function with TDF use in Africa [ 21 – 23 ], there are also studies that showed no significant association of TDF use with renal impairment [ 41 , 46 , 47 ]. The different results and reports on renal safety of TDF in various populations may suggest that TDF associated kidney injury may be developing in genetically predisposed populations.…”

Incidence and predictors of tenofovir disoproxil fumarate-induced renal impairment in HIV infected Nigerian patients

“…Similar studies undertaken in South Africa, Zambia, Uganda and Tanzania found no difference in the renal function of TDF exposed patients compared with TDF unexposed cohorts. 20,25,33,34 De Waal et al in a study of over 15,000 patients followed up for a median duration of 51 weeks reported an improvement on the kidney function of TDF treated patients that had mild renal dysfunction (<90 mL/min/1.73 sqm) at baseline. 20 The reasons for this difference may be attributed to the demographic and baseline clinical characteristics of the study population, as well as follow-up time.…”