Effect of Tenofovir Disoproxil Fumarate on Incidence of Chronic Kidney Disease and Rate of Estimated Glomerular Filtration Rate Decrement in HIV-1-Infected Treatment-Naïve Asian Patients: Results from 12-Year Observational Cohort.

Abstract

Little evidence is available for the incidence of chronic kidney disease (CKD) and rate of estimated glomerular filtration rate (eGFR) decrement among Asians with low body weight who are susceptible to tenofovir disoproxil fumarate (TDF) nephrotoxicity. In this 12-year observational cohort in Tokyo, we examined 1383 treatment-naïve HIV-1-infected Asians [720 started TDF-containing (TDF group) and 663 started non-TDF-containing (control) combination antiretroviral therapy (cART)]. The CKD incidence was calculated, and the effect of TDF use on CKD development was estimated using logistic regression. The eGFR slopes, before and after cART initiation, were estimated using mixed-effects linear spline models. Most patients were males (median weight, 62.6 kg; 83% started ritonavir-boosted protease inhibitors; median observation duration, 5.08 years). CKD developed in 150 patients (10.8%), with an incidence of 20.6 per 1000 person-years [confidence interval (95% CI), 17.6-24.2]. None developed end-stage renal disease. TDF use was associated with CKD [odds ratio (OR), 1.8; 95% CI, 1.00-3.13; p = 0.052]. The cumulative mean loss in the TDF group, relative to the control, increased over time after 1, 4, and 8 years of TDF exposure (-3.8, -5.5, and -9.0 mL/min/1.73 m2, respectively; p < 0.0001). The eGFR rapidly declined during the first 3 months of cART, particularly in the TDF group (-26.4 vs. -7.4 mL/min/1.73 m2/year in the control). In the TDF group, cART introduction was significantly associated with a faster rate of eGFR decline (from -0.44 to -2.11 mL/min/1.73 m2/year; p = 0.010), whereas in the control, the difference was not significant. For HIV-1-infected Asian patients with low body weight, TDF-containing cART is associated with CKD and faster eGFR declines.

• Authors: Soichiro Suzuki, Takeshi Nishijima, Yohei Kawasaki, Takuma Kurosawa, Yoshikazu Mutoh, Yoshimi Kikuchi, Hiroyuki Gatanaga, Shinichi Oka
• Journal: AIDS patient care and STDs (AIDS Patient Care STDS) Vol. 31 Issue 3 Pg. 105-112 (Mar 2017) ISSN: 1557-7449 [Electronic] United States
• PMID: 28282247 (Publication Type: Journal Article, Observational Study)

Chemical References

• Anti-HIV Agents
• HIV Protease Inhibitors
• Protease Inhibitors
• Reverse Transcriptase Inhibitors
• Tenofovir
• Ritonavir

Topics

• Adult
• Anti-HIV Agents (adverse effects, therapeutic use)
• Asian People (statistics & numerical data)
• Body Weight
• Cohort Studies
• Female
• Glomerular Filtration Rate (drug effects)
• HIV Infections (complications, drug therapy, virology)
• HIV Protease Inhibitors (administration & dosage, adverse effects)
• HIV-1 (drug effects, isolation & purification)
• Humans
• Incidence
• Male
• Protease Inhibitors (therapeutic use)
• Renal Insufficiency, Chronic (chemically induced, epidemiology, ethnology)
• Reverse Transcriptase Inhibitors (administration & dosage, adverse effects, therapeutic use)
• Ritonavir (therapeutic use)
• Tenofovir (adverse effects, therapeutic use)
• Tokyo