Decreased renal function in HIV-infected patients receiving tenofovir disoproxil fumarate-based antiretroviral regimen
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Abstract
Background: Tenofovir disoproxil fumarate (TDF) is currently considered as an essential component of major antiretroviral(ARV) regimens in combination with nonnucleoside reverse-transcriptase inhibitor- based regimen (NNRTI) or protease inhibitor(PI). This study aimed to determine the incidence and predictors of declined kidney function after the use of TDF during 2-year follow-up period.
Methods: A retrospective cohort study was conducted in our institute. We collected data from consecutive HIV-infected patients who received TDF-containing regimens, either with NNRTI or PI, in HIV clinic between January 2010 to December 2012. Kidney function was determined by creatinine clearance (CrCl) which was calculated using a modification of diet in renal disease (MDRD) equation at baseline and at 2-year follow-up.
Results: A total of 135 patients were included in the study, mean age 39.7 ± 8.5 years and a median of CD4 cell count 274 cell/mm3 (IQR 133-432). Seventy-four cases (54.8%) were female. At 2-year after initiation of TDF, 26 patients (19.3%) had decreased CrCl>25% from baseline. The presence of lipodystrophy (adjusted odds ratio, 2.16; 95% Cl, 0.66 to 7.01) was correlated with decline kidney function, but the presence of zidovudine-induced anemia (adjusted odds ratio, 0.45; 95% Cl, 0.10 to 2.20) and higher BMI (adjusted odds ratio, 0.84; 95% Cl, 0.70 to 1.02) were a factor that slows down the declined kidney function. However, they were not statistically significant risk factors. No discontinuation of TDF or significant clinical changes was observed among the study population during a follow-up period.
Conclusion: The incidence of declined kidney function in the patients using TDF treatment regimens was around 19.3% during 2-year follow-up period. Further study with more sample size, with a control group and long-term follow-up is needed.
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