title: Low body weight and tenofovir use are risk factors for renal dysfunction in Vietnamese HIV-infected patients. A prospective 18-month observation study.
abstract: BACKGROUND
  The use of tenofovir has been rapidly increasing in Vietnam. Several studies identified low body weight as a risk factor for tenofovir-induced nephrotoxicity. However, little is known about the impact of tenofovir on renal function in HIV-infected Vietnamese with generally low weight.
  
  
  METHODS
  An observational single-center cohort of adult HIV-infected patients on antiretroviral therapy at National Hospital of Tropical Diseases, Hanoi. Patients on tenofovir or with creatinine clearance ≤60 ml/min at baseline were excluded. The incidence of renal dysfunction was compared between patients who switched to tenofovir and those who did not. Renal dysfunction was defined as 25% decline of creatinine clearance from baseline. Time to renal dysfunction was analyzed by the Kaplan-Meier method between the two groups. The Cox hazard model was used to determine risk factors for renal dysfunction in uni- and multivariate analyses.
  
  
  RESULTS
  Of 556 patients enrolled in this study, 403 were non-tenofovir group while 153 were the tenofovir-switched group. Renal dysfunction occurred at a higher rate in the tenofovir-switched group (92.5 per 1000 person-years) than the non-tenofovir group (47.8 per 1000 person-years)(p = 0.023, Log-rank test). Multivariate analysis confirmed that tenofovir use, low body weight and glucosuria were significant risk factors for renal dysfunction (hazard ratio = 1.980; 95% confidential interval, 1.094-3.582, HR = 1.057; 95%CI, 1.016-1.098, HR = 5.202; 95%CI, 1.245-21.738, respectively).
  
  
  CONCLUSIONS
  Tenofovir use, low body weight and glucosuria were significant risk factors for renal dysfunction. We suggest close monitoring of renal function in patients with these risk factors even in resource-limited setting.
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for AIDS Research, Kumamoto University, Kumamoto, Japan. Electronic address: dmizushi@acc.ncgm.go.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Mizushima
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Tanuma
authors.affiliation: National Hospital of Tropical Diseases, Hanoi, Viet Nam.
authors.forename: Nguyen Thi
authors.initials: NT
authors.lastname: Dung
authors.affiliation: National Hospital of Tropical Diseases, Hanoi, Viet Nam.
authors.forename: Nguyen Hoai
authors.initials: NH
authors.lastname: Dung
authors.affiliation: National Hospital of Tropical Diseases, Hanoi, Viet Nam.
authors.forename: Nguyen Vu
authors.initials: NV
authors.lastname: Trung
authors.affiliation: National Hospital of Tropical Diseases, Hanoi, Viet Nam.
authors.forename: Nguyen Tien
authors.initials: NT
authors.lastname: Lam
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for AIDS Research, Kumamoto University, Kumamoto, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Gatanaga
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan.
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Kikuchi
authors.affiliation: National Hospital of Tropical Diseases, Hanoi, Viet Nam.
authors.forename: Nguyen
authors.initials: N
authors.lastname: Van Kinh
authors.affiliation: AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan; Center for AIDS Research, Kumamoto University, Kumamoto, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Oka
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000503:physiopathology* / Q000821:virology*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013851:Thinness / Q000503:physiopathology* / Q000821:virology; D014744:Vietnam
keywords: Human immunodeficiency virus; Low body weight; Renal dysfunction; Tenofovir; Vietnamese