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Is the risk of tenofovir‐induced nephrotoxicity similar in treatment‐naïve compared to treatment‐experienced patients?
Author(s) -
Low Joo Zheng,
Khoo Su Pei,
Nor Azmi Nuruljannah,
Chong Meng Li,
Sulaiman Helmi,
Azwa Iskandar,
Tan Ching Hooi,
Kamarulzaman Adeeba,
Rajasuriar Reena
Publication year - 2018
Publication title -
journal of pharmacy practice and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.222
H-Index - 22
eISSN - 2055-2335
pISSN - 1445-937X
DOI - 10.1002/jppr.1392
Subject(s) - medicine , tenofovir , renal function , nephrotoxicity , interquartile range , incidence (geometry) , kidney disease , creatinine , logistic regression , reverse transcriptase inhibitor , retrospective cohort study , gastroenterology , kidney , human immunodeficiency virus (hiv) , immunology , viral load , antiretroviral therapy , physics , optics
Background Tenofovir disoproxil fumarate ( TDF ) is the recommended first‐line nucleoside reverse transcriptase inhibitor ( NRTI ) in the management of human immunodeficiency virus ( HIV ); however, its use is associated with nephrotoxicity. Aim To assess if the risks of renal impairment were similar in treatment‐naïve compared to treatment‐experienced patients initiating tenofovir given their different background clinical characteristics. Method This was a retrospective observational study conducted at the University Malaya Medical Centre, Malaysia and included all HIV ‐infected adults who received tenofovir for at least 3 months and had an estimated glomerular filtration rate ( eGFR ) >60 mL /min at tenofovir initiation. The incidence of renal impairment was defined as a 25% decrease in eGFR from baseline or the development of chronic kidney disease. Clinical and demographic characteristics were extracted from medical records. Risk factors associated with tenofovir‐induced renal impairment were determined using multivariate logistic regression. Results This study included 314 patients and almost half of them (49%) were treatment‐naïve at tenofovir initiation. The majority of patients were male (89.5%) with a median (interquartile range) baseline creatinine clearance of 99.1 mL/min (85.0–114.0). Thirty (9.4%) patients developed tenofovir‐induced renal impairment and the incidence rate was higher in treatment‐experienced versus treatment‐naïve patients (7.0 vs 3.3 cases/100 person‐years, p = 0.049). Risk factors associated with tenofovir‐induced nephrotoxicity in multivariate analysis were older age (p = 0.001), anaemia (p = 0.027), concurrent hypertension (p = 0.014) and higher baseline eGFR (p = 0.007). Conclusion Treatment experience was not an independent risk factor but was rather confounded by multiple characteristics associated with an increased risk of TDF ‐induced nephrotoxicity. Monitoring all patients presenting with these risks regardless of treatment experience is crucial.