title: Low Incidence of Renal Dysfunction among HIV-Infected Patients on a Tenofovir-Based First Line Antiretroviral Treatment Regimen in Myanmar.
abstract: BACKGROUND
  Since 2004, Médecins Sans Frontières-Switzerland has provided treatment and care for people living with HIV in Dawei, Myanmar. Renal function is routinely monitored in patients on tenofovir (TDF)-based antiretroviral treatment (ART), and this provides an opportunity to measure incidence and risk factors for renal dysfunction.
  
  
  METHODS
  We used routinely collected program data on all patients aged ≥15 years starting first-line TDF-based ART between January 2012 and December 2013. Creatinine clearance (CrCl) was assessed at base line and six-monthly, with renal dysfunction defined as CrCl < 50 ml/min/1.73 m2. We calculated incidence of renal dysfunction and used Cox regression analysis to identify associated risk factors.
  
  
  RESULTS
  There were 1391 patients, of whom 1372 had normal renal function at baseline. Of these, 86 (6.3%) developed renal dysfunction during a median time of follow-up 1.14 years with an incidence rate of 5.4 per 100 person-years: 78 had CrCl between 30-50 ml/min/1.73 m2 and were maintained on TDF-based ART, but 5 were changed to another regimen: 4 because of CrCl <30 ml/min/1.73 m2. Risk factors for renal dysfunction included age ≥45 years, diagnosed diabetes, underlying renal disease, underweight and CD4 count <200 cells/mm3. There were 19 patients with baseline renal dysfunction and all continued on TDF-based ART: CrCl stayed between 30-49 ml/min/1.73 m2 in five patients while the remainder regained normal renal function.
  
  
  CONCLUSIONS
  In a resource-poor country like Myanmar, the low incidence of renal toxicity in our patient cohort suggests that routine assessment of CrCl may not be needed and could be targeted to high risk groups if resources permit.
authors: Médecins Sans Frontières- Switzerland, Yangon, Myanmar.
authors: Nang Thu Thu
authors: NT
authors: Kyaw
authors: International Union against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Anthony D
authors: AD
authors: Harries
authors: Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
authors: Palanivel
authors: P
authors: Chinnakali
authors: Médecins Sans Frontières, Bruxelles, Belgium.
authors: Annick
authors: A
authors: Antierens
authors: Médecins Sans Frontières- Switzerland, Yangon, Myanmar.
authors: Kyi Pyar
authors: KP
authors: Soe
authors: Médecins Sans Frontières, Geneva, Switzerland.
authors: Mike
authors: M
authors: Woodman
authors: Médecins Sans Frontières/Doctors Without Borders, New Delhi, India.
authors: Mrinalini
authors: M
authors: Das
authors: Médecins Sans Frontières- Switzerland, Yangon, Myanmar.
authors: Sharmila
authors: S
authors: Shetty
authors: Médecins Sans Frontières- Switzerland, Yangon, Myanmar.
authors: Moe Khine Lwin
authors: MK
authors: Zuu
authors: Médecins Sans Frontières- Switzerland, Yangon, Myanmar.
authors: Pyae Sone
authors: PS
authors: Htwe
authors: Médecins Sans Frontières- Switzerland, Yangon, Myanmar.
authors: Marcelo
authors: M
authors: Fernandez
mesh_terms: D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D002052:Myanmar; D051437:Renal Insufficiency / Q000139:chemically induced / Q000150:complications / Q000473:pathology*; D012307:Risk Factors; D013557:Switzerland; D000068698:Tenofovir / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000068698:Tenofovir; D003404:Creatinine