A consensus statement on the renal monitoring of Australian patients receiving tenofovir based antiviral therapy for HIV/HBV infection.
A number of antiviral agents used against Human Immunodeficiency Virus (HIV) infection and hepatitis B virus (HBV) mono or co-infection have been associated with real nephrotoxicity (including tenofovir disoproxil fumarate (TDF), atazanavir, indinavir and lopinavir) or apparent changes in renal function (e.g. cobicistat, ritonavir, rilpivirine and dolutegravir). Patients with HIV are at higher risk of acute and chronic renal dysfunction, so baseline assessment and ongoing monitoring of renal function is an important part of routine management of patients with HIV. Given the paucity of evidence in this area, we sought to establish a consensus view on how routine monitoring could be performed in Australian patients on ART regimens, especially those involving TDF. A group of nephrologists and prescribers (an HIV physician and a hepatologist) were assembled by Gilead to discuss practical and reasonable renal management strategies for patients particularly those on TDF-based combination regimens (in the case of those with HIV-infection) or on TDF-monotherapy (in the case of HBV-mono infection). The group considered which investigations should be performed as part of routine practice, their frequency, and when specialist renal referral is warranted. The algorithm presented suggests testing for serum creatinine along with plasma phosphate and an assessment of urinary protein (rather than albumin) and glucose. Here we advocate baseline tests of renal function at initiation of therapy. If creatinine excretion inhibitors (e.g. cobicistat or rilpivirine) are used as part of the ART regimen, we suggest creatinine is rechecked at 4 weeks and this value used as the new baseline. Repeat testing is suggested at 3-monthly intervals for a year and then at least yearly thereafter if no abnormalities are detected. In patients with abnormal baseline results, renal function assessment should be performed at least 6 monthly. In HBV mono-infected patients advocate that a similar testing protocol may be logical.
The Royal Melbourne Hospital and Faculty of Medicine University of Melbourne, 300 Grattan St, Parkville, Melbourne, VIC 3050 Australia.
Stephen G
SG
Holt
Royal Prince Alfred Hospital and Central Clinical School, Faculty of Medicine, University of Sydney, Missenden Rd, Camperdown, NSW 2050 Australia.
David M
DM
Gracey
Liverpool Hospital, Elizabeth St, Liverpool, NSW 2170 Australia.
Miriam T
MT
Levy
Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD 4102 Australia.
David W
DW
Mudge
Royal Perth Hospital, 197 Wellington St, Perth, WA 6000 Australia.
Ashley B
AB
Irish
Alfred Hospital, and Department of Medicine, Monash University, Melbourne, VIC 3004 Australia.
Rowan G
RG
Walker
Cairns Base Hospital, 165 The Esplanade, Cairns, QLD 4870 Australia.
Richard
R
Baer
St. Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW 2010 Australia.
Jacob
J
Sevastos
Medical Affairs, Gilead Sciences, Level 6, 417 St Kilda Road, Melbourne, VIC 3004 Australia.
Riaz
R
Abbas
Kirby Institute, UNSW, Sydney, NSW 2052 Australia.
Mark A
MA
Boyd
Fanconi syndrome; HIV; Hepatitis B; Monitoring; Renal failure; Tenofovir