Effect of changing from first- to second-line antiretroviral therapy on renal function: a retrospective study based on data from a single health facility in Namibia.
Tenofovir disoproxil fumarate (TDF) and lopinavir/ritonavir (LPV/r) can cause renal impairment with this combination co-administered during second-line combination antiretroviral therapy (cART) potentially associated with greater risk of nephrotoxicity. As a result, the aim of this study is to assess effects of second-line cART on renal function.



Retrospective longitudinal study in patients receiving cART.



71 patients received TDF, zidovudine or stavudine, each combined with 3TC/NVP or 3TC/EFV. Before second-line cART, 46.5% had abnormal kidney function. First-line cART had no relationship with calculated creatinine clearance (CrCl). During second-line cART, more males than females had abnormal renal function and more females experienced increases in CrCl. Calculated CrCl during second-line cART related strongly with CrCl during first-line cART. Time spent on cART had a weak relationship with CrCl.



Patients on first-line cART for several years without renal impairment may experience new onset impairment during second line cART. Patients with pre-existing renal impairment just before switching to second-line cART may experience a further decline.
a School of Pharmacy, Faculty of Health Sciences , University of Namibia , Windhoek , Namibia.
Francis
F
Kalemeera
a School of Pharmacy, Faculty of Health Sciences , University of Namibia , Windhoek , Namibia.
Christofina
C
Mbango
a School of Pharmacy, Faculty of Health Sciences , University of Namibia , Windhoek , Namibia.
Mwangana
M
Mubita
a School of Pharmacy, Faculty of Health Sciences , University of Namibia , Windhoek , Namibia.
Esther
E
Naikaku
b Department of Pharmacy , Nelson Mandela Metropolitan University , Port Elizabeth , South Africa.
Razia
R
Gaida
c Department of Laboratory Medicine, Division of Clinical Pharmacology , Karolinska Institutet, Karolinska University Hospital Huddinge , Stockholm , Sweden.|d Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.
Brian
B
Godman
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D003404:Creatinine / Q000097:blood*; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D007677:Kidney Function Tests; D008297:Male; D009276:Namibia; D012189:Retrospective Studies
D019380:Anti-HIV Agents; D003404:Creatinine
Namibia; combination antiretroviral therapy; creatinine clearance; drug utilisation study; renal function