Date Published: June 15, 2012
Publisher: BioMed Central
Author(s): Arlene C Chua, Ryan M Llorin, Kelvin Lai, Philippe Cavailler, Hwa Lin Law.
Tenofovirdisoproxilfumarate (TDF) is a nucleotide analogue widely recommended in international HIV treatment guidelines. The association of TDF and renal dysfunction has remained an area of interest.
We conducted a retrospective review of all patients on TDF from July 2007 to December 2009 in our institution and evaluated their renal function. Absolute change of creatinine clearance (CLCr) using Cockroft-Gault equation from baseline was calculated at 6, 12, 18 and 24 months. Overall, 226 patients were included in the study. Ninety percent were male. The median age was 46 yrs old (23–82), median weight was 60 kg (IQR 53.75-68), median CD4 count was 127 cells/mm3 (IQR 38–258) and median CLCr 82.7 mL/min (IQR 71.4-101.7) on initiation of TDF. The median decline of CLCr from baseline was −3.9 ml/min (IQR −12.3 to 7.6), and −3.6 ml/min (IQR −12.4 to 6.7) at 12 (n = 102), 24 months (n = 75) respectively. Eighteen of 226 patients had a decline in renal function to =50 ml/min. Majority of which had an improvement of CLCr on follow up. Only 80% of patients ever received monitoring of renal function. While we noted renal toxicity to be rare and transient among our cohort receiving TDF as part of their ARV regimen, these results reflect the short term renal effects of TDF given that ARV treatment is lifelong. Given that laboratory monitoring may be difficult to implement in many situations, future prospective studies looking into an evidence based algorithm for less frequent renal function monitoring than current guideline recommendations may be helpful.
Tenofovirdisoproxilfumarate (TDF) is a nucleotide analogue widely recommended in international HIV treatment guidelines [1-3].
We conducted a retrospective review of all patients who were started on an antiretroviral regimen containing TDF from July 2007 to December 2009 at the Communicable Disease Centre (CDC) at Tan Tock Seng Hospital (TTSH) in Singapore. Data was collected from review of medical records. Data on demographics, ARV, comorbidities and TDF dose were collected. Creatinine clearance (CLCr) was calculated using the Cockcroft-Gault equation.
From July 2007 to December 2009, there were a total of 226 patients who received an antiretroviral regimen containing TDF. Baseline demographic and clinical characteristics of patients receiving TDF are presented in Table 1.
Our study showed that in an Asian HIV population, majority of whom had a low CD4 count but relatively normal CLCr, the proportion of patients who develop renal toxicity is low (2.2%; 5/226). While use of protease inhibitor has been associated with greater decline in renal function , we are unable to show any significant difference which may be attributed to the small number in our study.
All authors declare that they have no competing interests.
AC wrote the manuscript, designed the study and analyzed the data. RL participated in the collection of data. PC participated in the collection of data and analyzed the data. KL participated in the collection of data. HL participated in the design of the study. All authors have read and approved the final manuscript.