Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Editorial
. 2018 Jan 1;4(1):37-40.
doi: 10.1016/S2055-6640(20)30245-4.

Prevalence and factors associated with renal dysfunction in patients on tenofovir disoproxil fumarate-based antiretroviral regimens for HIV infection in Southern India

Nagalingeswaran Kumarasamy  1 , Sruthi Sundaram  2 , Selvamuthu Poongulali  1 , Chandrasekaran Ezhilarasi  1 , Ambrose Pradeep  1 , Devaraj Chitra  1
Affiliations
Editorial

Prevalence and factors associated with renal dysfunction in patients on tenofovir disoproxil fumarate-based antiretroviral regimens for HIV infection in Southern India

Nagalingeswaran Kumarasamy et al. J Virus Erad. .

Abstract

Objectives: Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse transcriptase inhibitor commonly used in the treatment of HIV infection. This retrospective study aims to establish the prevalence of abnormal renal function among patients with HIV receiving TDF, and to investigate the risks for TDF-related renal dysfunction in this population.

Methods: Patients at the YRGCARE Medical Centre, Voluntary Health Services, receiving TDF-containing antiretroviral (ART) regimens between January 2002 and March 2017, were assessed for renal dysfunction using creatinine level and eGFR (DAIDS/NIH) during continuum of care. Demographic data and comorbidities were analysed for association with TDF toxicity. Data were obtained from the Natural History Study Database. Other causes of renal dysfunction were excluded.

Results: From the 14,118 patients on ART between 2002 and 2017 seen in the clinic, 7171 (50.8%) were initiated on TDF-containing regimens. Among these, 4400 were on a first-line NNRTI regimen, and 2771 on a second-line PI/r regimen, initiated after failure of first-line therapy. The majority of patients on ART were male, with a median age for the whole sample of 36 years (IQR 30-42). At ART initiation, the median CD4 cell count was 277 cells/mm3 (IQR 165-421) and the viral load (VL) 31,198 HIV-1 copies/mL (IQR 400-226,690). Median duration of follow-up was 5.1 years (IQR 2.3-9.5). The prevalence of renal dysfunction in patients taking TDF was 5.6%. Increased age, low BMI, low baseline CD4 cell count, hypertension and diabetes were associated with tenofovir toxicity (P<0.05). Concomitant PI use was not associated with increased risk for renal dysfunction (P>0.05).

Conclusions: The prevalence of renal dysfunction associated with TDF in our study population was higher than in other well-resourced settings, suggesting the need for increased renal parameter monitoring in patients in resource-limited settings. Treatment with ART should be initiated earlier and BMI should be maintained ≥18.5 kg/m2 through adequate nutrition and prevention of opportunistic infections. For patients with multiple comorbidities, tenofovir alafenamide (TAF) should be considered, instead of TDF, to avoid renal dysfunction.

Keywords: HIV, tenofovir disoproxil fumarate, toxicity, resource-limited settings, TAF, India.

PubMed Disclaimer

References

    1. World Health Organization HIV/AIDS Department Priority interventions: HIV/AIDS prevention, treatment, and care in the health sector. Geneva: World Health Organization, 2009. Available at: www.who.int/hiv/pub/priority_interventions_web.pdf ( accessed December 2017)
    1. Cihlar T, Ho ES, Lin DC, Mulato AS. Human renal organic anion transporter 1 (hOAT1) and its role in the nephrotoxicity of antiviral nucleotide analogs. Nucleosides Nucleotides Nucleic Acids 2001; 20: 641– 648. - PubMed
    1. Cooper RD, Wiebe N, Smith N et al. . Systematic review and meta-analysis: renal safety of tenofovir disoproxil fumarate in HIV-infected patients. Clin Infect Dis 2010; 51: 496– 505. - PubMed
    1. Crane HM, Kestenbaum B, Harrington RD, Kitahata MM. Amprenavir and didanosine are associated with declining kidney function among patients receiving tenofovir. AIDS 2007; 21: 1431– 1439. - PubMed
    1. Moore R, Keruly J, Gallant J. Tenofovir and renal dysfunction in clinical practice. Conference on Retroviruses and Opportunistic Infections. Los Angeles, CA, USA. February 2007. Abstract 832.

Publication types

LinkOut - more resources