title: Kidney dysfunction associated with tenofovir exposure in human immunodeficiency virus-1-infected Taiwanese patients.
abstract: OBJECTIVE
  Tenofovir disoproxil fumarate (TDF) is associated with kidney tubular dysfunction, for which the risk may vary among patients of different ethnicities. Data are limited, however, on the association between renal function changes and TDF exposure in human immunodeficiency virus (HIV)-infected Taiwanese patients.
  
  
  METHODS
  Medical records of HIV-infected Taiwanese patients seeking HIV care at a university hospital from 2011 to 2014 were reviewed. The change of estimated glomerular filtration rate (eGFR) was compared between patients not receiving combination antiretroviral therapy (cART) and those starting cART with or without TDF. The determinants of annual eGFR changes and factors associated with greater annual eGFR decline in TDF-exposed patients were explored.
  
  
  RESULTS
  A total of 775 patients were included: 140 were cART-naïve, 393 received TDF-containing cART, and 242 received cART without TDF. Compared with cART-naïve patients, the annual eGFR decline was greater in TDF-exposed patients (0.57 ± 8.6 mL/min/1.73 m2and 2.7 ± 8.9 mL/min/1.73 m2, p = 0.012). The annual eGFR decline between patients receiving cART with or without TDF was similar (2.7 ± 8.9 mL/min/1.73 m2and 1.8 ± 8.3 mL/min/1.73 m2, p = 0.567). Diabetes was associated with worsening eGFR decline in all studied patients. TDF exposure correlated with an additional annual eGFR decline of 2.73 mL/min/1.73 m2(95% confidence interval 0.139-5.326, p = 0.039) in patients with CD4 count < 350 cells/μL. Among TDF-exposed patients, the factors associated with annual eGFR decline of > 3 mL/min/1.73 m2were higher baseline eGFR and lower CD4 counts.
  
  
  CONCLUSIONS
  Among HIV-infected Taiwanese patients, cART exposure correlated with the decline of renal function. However, TDF-exposed patients are more likely to have prominent eGFR decline, especially those with higher baseline eGFR, advanced HIV disease, and diabetes.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
authors.forename: Yu-Shan
authors.initials: YS
authors.lastname: Huang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
authors.forename: Chieh-Kai
authors.initials: CK
authors.lastname: Chan
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Mao-Song
authors.initials: MS
authors.lastname: Tsai
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan.
authors.forename: Kuan-Yeh
authors.initials: KY
authors.lastname: Lee
authors.affiliation: Graduate Institute of Pharmacy, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Shu-Wen
authors.initials: SW
authors.lastname: Lin
authors.affiliation: Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Sui-Yuan
authors.initials: SY
authors.lastname: Chang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan; China Medical University, Taichung, Taiwan. Electronic address: hcc0401@ntu.edu.tw.
authors.forename: Chien-Ching
authors.initials: CC
authors.lastname: Hung
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000139:chemically induced* / Q000150:complications*; D012189:Retrospective Studies; D013624:Taiwan; D000068698:Tenofovir / Q000009:adverse effects* / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D000068698:Tenofovir
keywords: antiretroviral therapy; kidney dysfunction; nucleotide reverse-transcriptase inhibitor; proximal renal tubulopathy; tenofovir