Journal
PLOS ONE
Volume 11, Issue 8, Pages -Publisher
PUBLIC LIBRARY SCIENCE
DOI: 10.1371/journal.pone.0161562
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Funding
- U.S. National Institutes of Health's National Institute of Allergy and Infectious Diseases Eunice Kennedy Shriver National Institute of Child Health and Human Development
- National Cancer Institute, as part of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) [U01AI069907]
- Dutch Ministry of Foreign Affairs
- Stichting Aids Fonds
- Hong Kong Council for AIDS Trust Fund
- ViiV Healthcare
- Australian Government Department of Health and Ageing
- Faculty of Medicine, UNSW Australia
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Background In resource-limited settings, routine monitoring of renal function during antiretroviral therapy (ART) has not been recommended. However, concerns for tenofovir disoproxil fumarate (TDF)-related nephrotoxicity persist with increased use. Methods We investigated serum creatinine (S-Cr) monitoring rates before and during ART and the incidence and prevalence of renal dysfunction after starting TDF by using data from a regional cohort of HIV-infected individuals in the Asia-Pacific. Time to renal dysfunction was defined as time from TDF initiation to the decline in estimated glomerular filtration rate (eGFR) to < 60 ml/min/1.73m(2) with > 30% reduction from baseline using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation or the decision to stop TDF for reported TDF-nephrotoxicity. Predictors of S-Cr monitoring rates were assessed by Poisson regression and risk factors for developing renal dysfunction were assessed by Cox regression. Results Among 2,425 patients who received TDF, S-Cr monitoring rates increased from 1.01 to 1.84 per person per year after starting TDF (incidence rate ratio 1.68, 95% CI 1.62-1.74, p < 0.001). Renal dysfunction on TDF occurred in 103 patients over 5,368 person-years of TDF use (4.2%; incidence 1.75 per 100 person-years). Risk factors for developing renal dysfunction included older age (> 50 vs. <= 30, hazard ratio [HR] 5.39, 95% CI 2.52-11.50, p < 0.001; and using PI-based regimen (HR 1.93, 95% CI 1.22-3.07, p = 0.005). Having an eGFR prior to TDF (pre-TDF eGFR) of >= 60 ml/min/1.73m(2) showed a protective effect (HR 0.38, 95% CI, 0.17-0.85, p = 0.018). Conclusions Renal dysfunction on commencing TDF use was not common, however, older age, lower baseline eGFR and PI-based ART were associated with higher risk of renal dysfunction during TDF use in adult HIV-infected individuals in the Asia-Pacific region.
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