A chronic kidney disease risk score to determine tenofovir safety in a prospective cohort of HIV-positive male veterans.

Abstract

OBJECTIVE:

Tenofovir disoproxil fumarate is a widely used antiretroviral for HIV infection that has been associated with an increased risk of chronic kidney disease (CKD). Our objective was to derive a scoring system to predict 5-year risk of developing CKD in HIV-infected individuals and to estimate difference in risk associated with tenofovir use.

DESIGN:

We evaluated time to first occurrence of CKD (estimated glomerular filtration rate <60 ml/min per 1.73 m(2)) in 21 590 HIV-infected men from the Veterans Health Administration initiating antiretroviral therapy from 1997 to 2010.

METHODS:

We developed a point-based score using multivariable Cox regression models. Median follow-up was 6.3 years, during which 2059 CKD events occurred.

RESULTS:

Dominant contributors to the CKD risk score were traditional kidney risk factors (age, glucose, SBP, hypertension, triglycerides, proteinuria); CD4(+) cell count was also a component, but not HIV RNA. The overall 5-year event rate was 7.7% in tenofovir users and 3.8% in nonusers [overall adjusted hazard ratio 2.0, 95% confidence interval (CI) 1.8-2.2]. There was a progressive increase in 5-year CKD risk, ranging from less than 1% (zero points) to 16% (≥9 points) in nonusers of tenofovir, and from 1.4 to 21.4% among tenofovir users. The estimated number-needed-to-harm (NNH) for tenofovir use ranged from 108 for those with zero points to 20 for persons with at least nine points. Among tenofovir users with at least 1 year exposure, NNH ranged from 68 (zero points) to five (≥9 points).

CONCLUSION:

The CKD risk score can be used to predict an HIV-infected individual's absolute risk of developing CKD over 5 years and may facilitate clinical decision-making around tenofovir use.

• Authors: Rebecca Scherzer, Monica Gandhi, Michelle M Estrella, Phyllis C Tien, Steven G Deeks, Carl Grunfeld, Carmen A Peralta, Michael G Shlipak
• Journal: AIDS (London, England) (AIDS) Vol. 28 Issue 9 Pg. 1289-95 (Jun 01 2014) ISSN: 1473-5571 [Electronic] England
• PMID: 24922479 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Anti-HIV Agents
• Organophosphonates
• Tenofovir
• Adenine

Topics

• Adenine (adverse effects, analogs & derivatives, therapeutic use)
• Adult
• Anti-HIV Agents (adverse effects, therapeutic use)
• Cohort Studies
• HIV Infections (complications, drug therapy)
• Humans
• Male
• Middle Aged
• Organophosphonates (adverse effects, therapeutic use)
• Prospective Studies
• Renal Insufficiency, Chronic (chemically induced)
• Risk Assessment
• Tenofovir
• Veterans