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Title: Renal dysfunction during tenofovir use in a regional cohort of HIV-infected individuals in the Asia-Pacific
Authors: Junko Tanuma
Awachana Jiamsakul
Abhimanyu Makane
Anchalee Avihingsanon
Oon Tek Ng
Sasisopin Kiertiburanakul
Romanee Chaiwarith
Nagalingeswaran Kumarasamy
Kinh Van Nguyen
Thuy Thanh Pham
Man Po Lee
Rossana Ditangco
Tuti Parwati Merati
Jun Yong Choi
Wing Wai Wong
Adeeba Kamarulzaman
Evy Yunihastuti
Benedict Lh Sim
Winai Ratanasuwan
Pacharee Kantipong
Fujie Zhang
Mahiran Mustafa
Vonthanak Saphonn
Sanjay Pujari
Annette H. Sohn
C. V. Mean
V. Saphonn
K. Vohith
F. J. Zhang
H. X. Zhao
N. Han
P. C.K. Li
W. Lam
Y. T. Chan
K. H. Wong
S. Saghayam
C. Ezhilarasi
K. Joshi
D. N. Wirawan
F. Yuliana
D. Imran
A. Widhani
S. Oka
T. Nishijima
S. Na
J. M. Kim
Y. M. Gani
R. David
S. F.Syed Omar
S. Ponnampalavanar
I. Azwa
N. Huda
L. Y. Ong
E. Uy
R. Bantique
W. W. Ku
P. C. Wu
P. L. Lim
L. S. Lee
P. S. Ohnmar
P. Phanuphak
K. Ruxrungtham
P. Chusut
S. Sirivichayakul
S. Sungkanuparph
L. Chumla
N. Sanmeema
R. Chaiwarith
T. Sirisanthana
W. Kotarathititum
J. Praparattanapan
P. Kantipong
P. Kambua
R. Sriondee
V. H. Bui
T. T. Cao
D. D. Cuong
H. L. Ha
N. Durier
B. Petersen
T. Singtoroj
D. A. Cooper
M. G. Law
D. C. Boettiger
Keywords: Agricultural and Biological Sciences
Biochemistry, Genetics and Molecular Biology
Issue Date: 1-Aug-2016
Abstract: © 2016 Tanuma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 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/1.73m2with >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/1.73m2showed 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.
ISSN: 19326203
Appears in Collections:CMUL: Journal Articles

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