title: Proximal renal tubular dysfunction related to antiretroviral therapy among HIV-infected patients in an HIV clinic in Mexico.
abstract: Proximal renal tubular dysfunction (PRTD) of varying severity has been associated with antiretroviral toxicity, especially related to the use of tenofovir (TDF). The aim of this study was to investigate whether HIV-infected patients who use a tenofovir-based regimen are at increased risk of tubular dysfunction. We conducted an observational, comparative, longitudinal, prospective study. Estimated glomerular filtration rate (eGFR) and markers of tubular damage to assess tubular dysfunction (fractional excretion of phosphate and uric acid, glycosuria, and proteinuria) were measured at baseline and at weeks 12 and 24. Of 111 participants, PRTD was found in 6.3% at week 12 and 9% at week 24, with no statistically significant difference between those on an abacavir (ABC)-containing regimen or a TDF-containing regimen. We also found an increase in triglycerides associated with the ABC-containing regimen compared with the TDF group. The use of an ABC- or TDF-containing regimen was independently associated with tubular dysfunction, but we found no significant differences between these groups, except when TDF was combined with a protease inhibitor. A better and more complete assessment of renal function is needed, because the presence of tubular dysfunction and proteinuria without impairment of eGFR may affect the renal safety of HIV-infected patients.
authors.affiliation: 1 Department of Nephrology, Hospital de Infectología "La Raza", National Medical Center , IMSS, Mexico City, Mexico .
authors.forename: Karen
authors.initials: K
authors.lastname: Andrade-Fuentes
authors.forename: José A
authors.initials: JA
authors.lastname: Mata-Marín
authors.forename: José I
authors.initials: JI
authors.lastname: López-De León
authors.forename: Bulmaro
authors.initials: B
authors.lastname: Manjarrez-Téllez
authors.forename: Jorge L Sandoval
authors.initials: JL
authors.lastname: Ramírez
authors.forename: Jesús
authors.initials: J
authors.lastname: Gaytan-Martínez
mesh_terms: D000225:Adenine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D015224:Dideoxynucleosides; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007687:Kidney Tubules, Proximal / Q000187:drug effects* / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008800:Mexico; D008875:Middle Aged; D063065:Organophosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000627:therapeutic use; D011507:Proteinuria / Q000139:chemically induced / Q000503:physiopathology; D000068698:Tenofovir; D000099227:Abacavir
chemical_list: D000225:Adenine; D019380:Anti-HIV Agents; D015224:Dideoxynucleosides; D063065:Organophosphonates; D011480:Protease Inhibitors; D000068698:Tenofovir; D000099227:Abacavir