title: Renal toxicity of long-term therapy with tenofovir in HIV-infected patients.
abstract: Data are sparse on long-term renal toxicity of tenofovir as measured by estimated glomerular filtration rate (eGFR) and progression to advanced stages of chronic kidney disease (CKD). The objective of the study is to determine the incidence of renal impairment associated with the use of tenofovir in HIV-infected patients, using abacavir as a control. In a single tertiary care center, all HIV-infected patients with baseline CKD stage 0 or 1 (CKD-1), who were started on either tenofovir or abacavir from 1998 to 2008 and had at least 1 follow-up eGFR measure on therapy, were included in this retrospective analysis. Progression to CKD stages 2 to 5 was compared using Kaplan-Meier analysis. Progression to CKD-2 and CKD-3 occurred more frequently in patients who received tenofovir than those receiving abacavir (CKD-2, 2-year actuarial frequency, 48.8% vs 23.7%; P < .001, log rank; CKD-3, 5.8% vs 0.0%; P = .028). Only 1 patient in the tenofovir group progressed to CKD-4 and none to CKD-5. Treatment with tenofovir was the only independent factor associated with progression to CKD-2 (hazard ratio [HR], 2.12; 95% confidence interval [CI]: 1.41-3.18; P < .001) and to CKD-3 (HR, 4.91; 95% CI, 1.02-23.7; P = .048). In HIV-infected patients, long-term therapy with tenofovir is associated with mild-to-moderate nephrotoxicity which is significantly higher than in abacavir-treated patients.
authors.affiliation: Clinical Pharmacy Specialist-Emergency Medicine and Infectious Diseases, Kingsbrook Jewish Medical Center, Brooklyn, NY, USA. mmonteagudochu@kingsbrook.org
authors.forename: Maricelle O
authors.initials: MO
authors.lastname: Monteagudo-Chu
authors.forename: Mei H
authors.initials: MH
authors.lastname: Chang
authors.forename: Horatio B
authors.initials: HB
authors.lastname: Fung
authors.forename: Norbert
authors.initials: N
authors.lastname: Bräu
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015224:Dideoxynucleosides / Q000009:adverse effects / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D006787:Hospitals, Veterans; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D063065:Organophosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D010044:Outpatient Clinics, Hospital; D010865:Pilot Projects; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000139:chemically induced* / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D000068698:Tenofovir; D000099227:Abacavir
chemical_list: D000225:Adenine; D019380:Anti-HIV Agents; D015224:Dideoxynucleosides; D063065:Organophosphonates; D018894:Reverse Transcriptase Inhibitors; D000068698:Tenofovir; D000099227:Abacavir