title: Renal impairment in HIV-1 infected patients receiving antiretroviral regimens including tenofovir in a resource-limited setting.
abstract: A retrospective cohort study was conducted among HIV-1 infected patients taking tenofovir as part of an anti-HIV drug regimen in a resource-limited setting in Thailand. One hundred thirty patients with a mean_SD age of 39.7+/-7.4 years, of whom 55% were male, were included in the study. Fifty-eight (45%), 48 (37%), and 24 (18%) patients concurrently received nevirapine-based, efavirenz-based, and protease inhibitor (PI)-based regimens, respectively. The median (IQR) value for serum creatinine was 0.8 (0.6-0.9) mg/dl, for eGFR was 103 (96-120) ml/min/1.73 m2 and for CD4 was 302 (194-511) cells/mm3 at the time of tenofovir initiation. At 3-6 months, the median (IQR) eGFR was 100 (88-117) ml/min/1.73 m2 (p=0.002, compared to baseline). The proportions of patients with an estimated glomerular filtration rate (eGFR)<30 ml/min/1.73 m2 at baseline and 3-6 months were 0% and 2%, respectively (p<0.001). At 6-months follow-up, 2 patients (1.4%) were diagnosed with acute renal failure at 3 weeks and 9 weeks after tenofovir use, respectively. Both patients received a boosted PI in the regimen. Overall, the incidence of acute renal failure was 0.26 per 100 person-months. Renal function progressed to irreversible renal failure in one patient. In summary, tenofovir-associated renal impairment is not uncommon in a real-life practice. This report highlights the potentially irreversible adverse effect of this agent, particularly in patients with vulnerable kidneys and concomitant use of tenofovir and boosted PI.
authors.affiliation: Bamrasnaradura Infectious Diseases Institute, Ministry of Public Health, Nonthaburi, Thailand. drweerawat@hotmail.com
authors.forename: Weerawat
authors.initials: W
authors.lastname: Manosuthi
authors.forename: Wisit
authors.initials: W
authors.lastname: Prasithsirikul
authors.forename: Preecha
authors.initials: P
authors.lastname: Tantanathip
authors.forename: Sukanya
authors.initials: S
authors.lastname: Chimsuntorn
authors.forename: Samruay
authors.initials: S
authors.lastname: Nilkamhang
authors.forename: Somnuek
authors.initials: S
authors.lastname: Sungkanuparph
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D011480:Protease Inhibitors / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D012189:Retrospective Studies; D000068698:Tenofovir; D013785:Thailand / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D063065:Organophosphonates; D011480:Protease Inhibitors; D000068698:Tenofovir; D000225:Adenine