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Renal Dysfunction during Tenofovir Use in a Regional Cohort of HIV-Infected Individuals in the Asia-Pacific.

Renal Dysfunction during Tenofovir Use in a Regional Cohort of HIV-Infected Individuals in the Asia-Pacific.
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Tanuma J, Jiamsakul A, Makane A, Avihingsanon A, Ng OT, Kiertiburanakul S, Chaiwarith R, Kumarasamy N, Nguyen KV, Pham TT, Lee MP, Ditangco R, Merati TP, Choi JY, Wong WW, Kamarulzaman A, Yunihastuti E, Sim BL, Ratanasuwan W, Kantipong P, Zhang F, Mustafa M, Saphonn V, Pujari S, Sohn AH, ,


Tanuma J, Jiamsakul A, Makane A, Avihingsanon A, Ng OT, Kiertiburanakul S, Chaiwarith R, Kumarasamy N, Nguyen KV, Pham TT, Lee MP, Ditangco R, Merati TP, Choi JY, Wong WW, Kamarulzaman A, Yunihastuti E, Sim BL, Ratanasuwan W, Kantipong P, Zhang F, Mustafa M, Saphonn V, Pujari S, Sohn AH, , (click to view)

Tanuma J, Jiamsakul A, Makane A, Avihingsanon A, Ng OT, Kiertiburanakul S, Chaiwarith R, Kumarasamy N, Nguyen KV, Pham TT, Lee MP, Ditangco R, Merati TP, Choi JY, Wong WW, Kamarulzaman A, Yunihastuti E, Sim BL, Ratanasuwan W, Kantipong P, Zhang F, Mustafa M, Saphonn V, Pujari S, Sohn AH, ,

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PloS one 2016 08 2511(8) e0161562 doi 10.1371/journal.pone.0161562

Abstract
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/1.73m2 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/1.73m2 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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