title: Renal safety of a tenofovir-containing first line regimen: experience from an antiretroviral cohort in rural Lesotho.
abstract: BACKGROUND
  Current guidelines contraindicate TDF use when creatinine clearance (CrCl) falls below 50 ml/min. We report prevalence of abnormal renal function at baseline and factors associated with abnormal renal function from a community cohort in Lesotho.
  
  
  METHODS
  We calculated changes in CrCl from baseline for patients initiated on TDF at 6 and 12 months and the proportion of patients initiated on TDF who developed renal impairment. Screening algorithms were developed using risk factors determined by multivariate analysis.
  
  
  RESULTS
  Among 933 adults for whom baseline creatinine was available, 176 (18.9%) presented with a baseline CrCl <50 ml/min. Renal function improved during follow-up. 19 patients who developed renal toxicity during follow up remained on TDF; renal function improved (CrCl≥50 ml/min) in all but 3 of these patients. Among 15 patients with a baseline CrCl <50 ml/min were started in error, none developed severe renal impairment.
  
  
  CONCLUSIONS
  In this setting TDF-associated renal toxicity is rare and mainly transient. Further studies to assess TDF safety at lower CrCl thresholds are warranted.
authors.affiliation: Médecins Sans Frontières, Morija, Lesotho. helen.bygrave@joburg.msf.org
authors.forename: Helen
authors.initials: H
authors.lastname: Bygrave
authors.forename: Katharina
authors.initials: K
authors.lastname: Kranzer
authors.forename: Katherine
authors.initials: K
authors.lastname: Hilderbrand
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jouquet
authors.forename: Eric
authors.initials: E
authors.lastname: Goemaere
authors.forename: Nathalie
authors.initials: N
authors.lastname: Vlahakis
authors.forename: Laura
authors.initials: L
authors.lastname: Triviño
authors.forename: Lipontso
authors.initials: L
authors.lastname: Makakole
authors.forename: Nathan
authors.initials: N
authors.lastname: Ford
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology; D000328:Adult; D000465:Algorithms; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000494:pharmacology*; D015331:Cohort Studies; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D007677:Kidney Function Tests; D007927:Lesotho; D008297:Male; D063065:Organophosphonates / Q000009:adverse effects* / Q000494:pharmacology*; D015397:Program Evaluation; D012307:Risk Factors; D012424:Rural Population; D000068698:Tenofovir
chemical_list: D044966:Anti-Retroviral Agents; D063065:Organophosphonates; D000068698:Tenofovir; D003404:Creatinine; D000225:Adenine