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Changes in renal function with long‐term exposure to antiretroviral therapy in HIV‐infected adults in Asia
Author(s) -
Joshi Kedar,
Boettiger David,
Kerr Stephen,
Nishijima Takeshi,
Van Nguyen Kinh,
Ly Penh Sun,
Lee Man Po,
Kumarasamy Nagalingeswaran,
Wong Wingwai,
Kantipong Pacharee,
Cuong Do Duy,
Kamarulzaman Adeeba,
Choi Jun Yong,
Zhang Fujie,
Chaiwarith Romanee,
Ng Oon Tek,
Kiertiburanakul Sasisopin,
Sim Benedict Lim Heng,
Merati Tuti Parwati,
Yunihastuti Evy,
Ditangco Rossana,
Ross Jeremy,
Pujari Sanjay
Publication year - 2018
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4657
Subject(s) - medicine , renal function , kidney disease , creatinine , population , incidence (geometry) , environmental health , physics , optics
Purpose Renal disease is common among people living with human immunodeficiency virus (HIV). However, there is limited information on the incidence and risk factors associated with renal dysfunction among this population in Asia. Methods We used data from the TREAT Asia HIV Observational Database. Patients were included if they started antiretroviral therapy during or after 2003, had a serum creatinine measurement at antiretroviral therapy initiation (baseline), and had at least 2 follow‐up creatinine measurements taken ≥3 months apart. Patients with a baseline estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m 2 were excluded. Chronic kidney disease was defined as 2 consecutive eGFR values ≤60 mL/min/1.73 m 2 taken ≥3 months apart. Generalized estimating equations were used to identify factors associated with eGFR change. Competing risk regression adjusted for study site, age and sex, and cumulative incidence plots were used to evaluate factors associated with chronic kidney disease (CKD). Results Of 2547 patients eligible for this analysis, tenofovir was being used by 703 (27.6%) at baseline. Tenofovir use, high baseline eGFR, advanced HIV disease stage, and low nadir CD4 were associated with a decrease in eGFR during follow‐up. Chronic kidney disease occurred at a rate of 3.4 per 1000 patient/years. Factors associated with CKD were tenofovir use, old age, low baseline eGFR, low nadir CD4, and protease inhibitor use. Conclusions There is an urgent need to enhance renal monitoring and management capacity among at‐risk groups in Asia and improve access to less nephrotoxic antiretrovirals.