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Volume 50, Number 5, October 2017

Kidney dysfunction associated with tenofovir exposure in human immunodeficiency virus-1-infected Taiwanese patients 


Yu-Shan Huang, Chieh-Kai Chan, Mao-Song Tsai, Kuan-Yeh Lee, Shu-Wen Lin, Sui-Yuan Chang, Chien-Ching Hung, Shan-Chwen Chang


 

Corresponding author:

Chien-Ching Hung, Corresponding author. Department of Internal Medicine, National Taiwan University Hospital, Number 7 Chung-Shan South Road, Taipei, Taiwan. 



 

Background and purpose: 

Tenofovir disoproxil fumarate (TDF) is associated with kidney tubular dysfunction, for which the risk may vary among patients of different ethnicities. Data are limited, however, on the association between renal function changes and TDF exposure in human immunodeficiency virus (HIV)-infected Taiwanese patients.
 



 

Methods:

Medical records of HIV-infected Taiwanese patients seeking HIV care at a university hospital from 2011 to 2014 were reviewed. The change of estimated glomerular filtration rate (eGFR) was compared between patients not receiving combination antiretroviral therapy (cART) and those starting cART with or without TDF. The determinants of annual eGFR changes and factors associated with greater annual eGFR decline in TDF-exposed patients were explored. 



 

Results:

A total of 775 patients were included: 140 were cART-naïve, 393 received TDF-containing cART, and 242 received cART without TDF. Compared with cART-naïve patients, the annual eGFR decline was greater in TDF-exposed patients (0.57 ± 8.6 mL/min/1.73 m2 and 2.7 ± 8.9 mL/min/1.73 m2, p = 0.012). The annual eGFR decline between patients receiving cART with or without TDF was similar (2.7 ± 8.9 mL/min/1.73 m2 and 1.8 ± 8.3 mL/min/1.73 m2, p = 0.567). Diabetes was associated with worsening eGFR decline in all studied patients. TDF exposure correlated with an additional annual eGFR decline of 2.73 mL/min/1.73 m2 (95% confidence interval 0.139–5.326, p = 0.039) in patients with CD4 count < 350 cells/μL. Among TDF-exposed patients, the factors associated with annual eGFR decline of > 3 mL/min/1.73 m2 were higher baseline eGFR and lower CD4 counts. 



 

Conclusion:

Among HIV-infected Taiwanese patients, cART exposure correlated with the decline of renal function. However, TDF-exposed patients are more likely to have prominent eGFR decline, especially those with higher baseline eGFR, advanced HIV disease, and diabetes. 



 

Key words:

antiretroviral therapy, kidney dysfunction, nucleotide reverse-transcriptase inhibitor, proximal renal tubulopathy, tenofovir