Proximal renal tubular dysfunction related to antiretroviral therapy among HIV-infected patients in an HIV clinic in Mexico.

Abstract

Proximal renal tubular dysfunction (PRTD) of varying severity has been associated with antiretroviral toxicity, especially related to the use of tenofovir (TDF). The aim of this study was to investigate whether HIV-infected patients who use a tenofovir-based regimen are at increased risk of tubular dysfunction. We conducted an observational, comparative, longitudinal, prospective study. Estimated glomerular filtration rate (eGFR) and markers of tubular damage to assess tubular dysfunction (fractional excretion of phosphate and uric acid, glycosuria, and proteinuria) were measured at baseline and at weeks 12 and 24. Of 111 participants, PRTD was found in 6.3% at week 12 and 9% at week 24, with no statistically significant difference between those on an abacavir (ABC)-containing regimen or a TDF-containing regimen. We also found an increase in triglycerides associated with the ABC-containing regimen compared with the TDF group. The use of an ABC- or TDF-containing regimen was independently associated with tubular dysfunction, but we found no significant differences between these groups, except when TDF was combined with a protease inhibitor. A better and more complete assessment of renal function is needed, because the presence of tubular dysfunction and proteinuria without impairment of eGFR may affect the renal safety of HIV-infected patients.

• Authors: Karen Andrade-Fuentes, José A Mata-Marín, José I López-De León, Bulmaro Manjarrez-Téllez, Jorge L Sandoval Ramírez, Jesús Gaytan-Martínez
• Journal: AIDS patient care and STDs (AIDS Patient Care STDS) Vol. 29 Issue 4 Pg. 181-5 (Apr 2015) ISSN: 1557-7449 [Electronic] United States
• PMID: 25101526 (Publication Type: Journal Article, Observational Study)

Chemical References

• Anti-HIV Agents
• Dideoxynucleosides
• Organophosphonates
• Protease Inhibitors
• Tenofovir
• Adenine
• abacavir

Topics

• Adenine (adverse effects, analogs & derivatives, therapeutic use)
• Adolescent
• Adult
• Anti-HIV Agents (adverse effects, therapeutic use)
• Antiretroviral Therapy, Highly Active (adverse effects)
• Dideoxynucleosides
• Drug Therapy, Combination
• Female
• Glomerular Filtration Rate
• HIV Infections (complications, drug therapy, physiopathology)
• Humans
• Kidney Tubules, Proximal (drug effects, physiopathology)
• Longitudinal Studies
• Male
• Mexico
• Middle Aged
• Organophosphonates (adverse effects, therapeutic use)
• Prospective Studies
• Protease Inhibitors (therapeutic use)
• Proteinuria (chemically induced, physiopathology)
• Tenofovir