Is the risk of tenofovir-induced nephrotoxicity similar in treatment-naïve compared to treatment-experienced patients?
Document Type
Article
Publication Date
1-1-2018
Abstract
Background: Tenofovir disoproxil fumarate (TDF) is the recommended first-line nucleoside reverse transcriptase inhibitor (NRTI) in the management of human immunodeficiency virus (HIV); however, its use is associated with nephrotoxicity. Aim: To assess if the risks of renal impairment were similar in treatment-naïve compared to treatment-experienced patients initiating tenofovir given their different background clinical characteristics. Method: This was a retrospective observational study conducted at the University Malaya Medical Centre, Malaysia and included all HIV-infected adults who received tenofovir for at least 3 months and had an estimated glomerular filtration rate (eGFR) >60 mL/min at tenofovir initiation. The incidence of renal impairment was defined as a 25% decrease in eGFR from baseline or the development of chronic kidney disease. Clinical and demographic characteristics were extracted from medical records. Risk factors associated with tenofovir-induced renal impairment were determined using multivariate logistic regression. Results: This study included 314 patients and almost half of them (49%) were treatment-naïve at tenofovir initiation. The majority of patients were male (89.5%) with a median (interquartile range) baseline creatinine clearance of 99.1 mL/min (85.0–114.0). Thirty (9.4%) patients developed tenofovir-induced renal impairment and the incidence rate was higher in treatment-experienced versus treatment-naïve patients (7.0 vs 3.3 cases/100 person-years, p = 0.049). Risk factors associated with tenofovir-induced nephrotoxicity in multivariate analysis were older age (p = 0.001), anaemia (p = 0.027), concurrent hypertension (p = 0.014) and higher baseline eGFR (p = 0.007). Conclusion: Treatment experience was not an independent risk factor but was rather confounded by multiple characteristics associated with an increased risk of TDF-induced nephrotoxicity. Monitoring all patients presenting with these risks regardless of treatment experience is crucial.
Keywords
HIV, nephrotoxicity, renal impairment, tenofovir, tenofovir disoproxil fumarate
Publication Title
Journal of Pharmacy Practice and Research
Divisions
fac_med
Funders
High Impact Research/Ministry of Higher Education Research Grant, Malaysia (HIR/MOHE; H-20001-E000091) and UMRG (RP029– 14HTM)
Volume
48
Issue
3
Publisher
Wiley