Tenofovir-associated renal toxicity in a cohort of HIV infected patients in Ghana

Edmund T Nartey, Raymond A Tetteh, Barbara A Yankey, Aukje K Mantel-Teeuwisse, Hubert G M Leufkens, Alexander N O Dodoo, Margaret Lartey, Edmund T Nartey, Raymond A Tetteh, Barbara A Yankey, Aukje K Mantel-Teeuwisse, Hubert G M Leufkens, Alexander N O Dodoo, Margaret Lartey

Abstract

Objective: Tenofovir disoproxil fumarate (TDF) is a nucleotide analogue recommended in international HIV treatment guidelines. Purpose of this study was to estimate the long term effects of TDF on renal profile in a cohort of HIV patients in Ghana. Three hundred (300) consecutive HIV-positive patients who initiated TDF-based antiretroviral treatment in 2008 at the Korle-Bu Teaching Hospital were sampled. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault equation at baseline and renal impairment was defined as CrCl values of 30.0-49.9 mL/min (moderate renal impairment) and < 30 mL/min (severe renal impairment) as per institutional guidelines for renal function test.

Results: Median follow up time was 2.9 years (IQR 2.3-3.4 years). At study endpoint, 63 participants (21.0% [95% CI 6.5-26.1]) recorded CrCl rate below 50 mL/min indicating incident renal impairment, made up of 18.3% moderate renal impairment and 2.3% severe renal impairment. Factors associated with incidence of renal impairment were increasing age, decrease in creatinine clearance rate at baseline, WHO HIV stage III/IV and participants with BMI of < 18.5 kg/m2. Patients with identified renal impairment risk factors at ART initiation should be targeted and monitored effectively to prevent renal injury.

Keywords: ART; Creatinine clearance; HIV; Renal dysfunction; Tenofovir disoproxil fumarate.

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. World Health Organisation (WHO) Global update on HIV treatment 2013: results, impact and opportunities. Geneva: WHO; 2013. p. 2013.
    1. Ghana AIDS Commisssion (GAC). Ghana’s progress report on the United Nations General Assembly Special Session (UNGASS) declaration of commitment on HIV and AIDS Geneva, Switzerland: GAC; 2013.
    1. Eluwa GI, Badru T, Agu KA, Akpoigbe KJ, Chabikuli O, Hamelmann C. Adverse drug reactions to antiretroviral therapy (ARVs): incidence, type and risk factors in Nigeria. BMC Clin Pharmacol. 2012;12:7. doi: 10.1186/1472-6904-12-7.
    1. Estrella M, Moosa M, Nachega J. Risk and benefits of tenofovir in the context of kidney dysfunction in sub-Sarahan Africa. CID. 2014;58(10):1481–1483. doi: 10.1093/cid/ciu123.
    1. Gallant JE, Staszewski S, Pozniak AL, DeJesus E, Suleiman JM, Miller MD, et al. Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial. JAMA. 2004;292:191–201. doi: 10.1001/jama.292.2.191.
    1. Horberg M, Tang B, Towner W, Silverberg M, Bersoff-Matcha S, Hurley L, et al. Impact of tenofovir on renal function in HIV-infected, antiretroviral-naive patients. J Acquir Immune Defic Syndr. 2010;53:62–69. doi: 10.1097/QAI.0b013e3181be6be2.
    1. Calza L, Trapani F, Tedeschi S, Piergentili B, Manfredi R, Colangeli V, et al. Tenofovir-induced renal toxicity in 324 HIV-infected, antiretroviral-naive patients. Scand J Infect Dis. 2011;43:656–660. doi: 10.3109/00365548.2011.572906.
    1. Chua AC, Llorin RM, Lai K, Cavailler P, Law HL. Renal safety of tenofovir containing antiretroviral regimen in a Singapore cohort. AIDS Res Ther. 2012;9:19. doi: 10.1186/1742-6405-9-19.
    1. De Beaudrap P, Diallo MB, Landman R, Gueye NF, Ndiaye I, Diouf A, et al. Changes in the renal function after tenofovir-containing antiretroviral therapy initiation in a Senegalese cohort (ANRS 1215) AIDS Res Hum Retroviruses. 2010;26:1221–1227. doi: 10.1089/aid.2009.0261.
    1. Nishijima T, Komatsu H, Gatanaga H, Aoki T, Watanabe K, Kinai E, et al. Impact of small body weight on tenofovir-associated renal dysfunction in HIV-infected patients: a retrospective cohort study of Japanese patients. PLoS ONE. 2011;6:e22661. doi: 10.1371/journal.pone.0022661.
    1. Cooper RD, Wiebe N, Smith N, Keiser P, Naicker S, Tonelli M. Systematic review and meta-analysis: renal safety of tenofovir disoproxil fumarate in HIV-infected patients. Clin Infect Dis. 2010;51:496–505. doi: 10.1086/655681.
    1. Madeddu G, Bonfanti P, De Socio GV, Carradori S, Grosso C, Marconi P, et al. Tenofovir renal safety in HIV-infected patients: results from the SCOLTA Project. Biomed Pharmacother. 2008;62:6–11. doi: 10.1016/j.biopha.2007.04.008.
    1. Goicoechea M, Liu S, Best B, Sun S, Jain S, Kemper C, et al. Greater tenofovir-associated renal function decline with protease inhibitor-based versus nonnucleoside reverse-transcriptase inhibitor-based therapy. J Infect Dis. 2008;197:102–108. doi: 10.1086/524061.
    1. Quesada PR, Esteban LL, Garcia JR, Sanchez RV, Garcia TM, Alonso-Vega GG, et al. Incidence and risk factors for tenofovir-associated renal toxicity in HIV-infected patients. Int J Clin Pharm. 2015;37:865–872. doi: 10.1007/s11096-015-0132-1.
    1. Kamkuemah M, Kaplan R, Bekker LG, Little F, Myer L. Renal impairment in HIV-infected patients initiating tenofovir-containing antiretroviral therapy regimens in a Primary Healthcare Setting in South Africa. Trop Med Int Health. 2015;20:518–526. doi: 10.1111/tmi.12446.
    1. World Health Organisation (WHO) Consolidated guideliness for treatment of persons living with HIV. Geneva: WHO; 2015.
    1. National AIDS Control Program (NACP). Guidelines for antiretroviral therapy in Ghana. Accra; 2014.
    1. Bygrave H, Kranzer K, Hilderbrand K, Jouquet G, Goemaere E, Vlahakis N, et al. Renal safety of a tenofovir-containing first line regimen: experience from an antiretroviral cohort in rural Lesotho. PLoS ONE. 2011;6:e17609. doi: 10.1371/journal.pone.0017609.
    1. Korle-Bu Teaching Hospital (KBTH). Korle-Bu teaching hospital annual report-2012. Accra. Ghana: KBTH 2012.
    1. Karras DL, Helpern KL, Riley LJ, Hughes L, Gaughan JP. Urine dipstick as screening test for serum creatinine elevation in emergency department patients with severe hypertension. Acad Emerg Med. 2002;9:27–34. doi: 10.1197/aemj.9.1.27.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться