Low body weight and tenofovir use are risk factors for renal dysfunction in Vietnamese HIV-infected patients. A prospective 18-month observation study.

Abstract

BACKGROUND:

The use of tenofovir has been rapidly increasing in Vietnam. Several studies identified low body weight as a risk factor for tenofovir-induced nephrotoxicity. However, little is known about the impact of tenofovir on renal function in HIV-infected Vietnamese with generally low weight.

METHODS:

An observational single-center cohort of adult HIV-infected patients on antiretroviral therapy at National Hospital of Tropical Diseases, Hanoi. Patients on tenofovir or with creatinine clearance ≤60 ml/min at baseline were excluded. The incidence of renal dysfunction was compared between patients who switched to tenofovir and those who did not. Renal dysfunction was defined as 25% decline of creatinine clearance from baseline. Time to renal dysfunction was analyzed by the Kaplan-Meier method between the two groups. The Cox hazard model was used to determine risk factors for renal dysfunction in uni- and multivariate analyses.

RESULTS:

Of 556 patients enrolled in this study, 403 were non-tenofovir group while 153 were the tenofovir-switched group. Renal dysfunction occurred at a higher rate in the tenofovir-switched group (92.5 per 1000 person-years) than the non-tenofovir group (47.8 per 1000 person-years)(p = 0.023, Log-rank test). Multivariate analysis confirmed that tenofovir use, low body weight and glucosuria were significant risk factors for renal dysfunction (hazard ratio = 1.980; 95% confidential interval, 1.094-3.582, HR = 1.057; 95%CI, 1.016-1.098, HR = 5.202; 95%CI, 1.245-21.738, respectively).

CONCLUSIONS:

Tenofovir use, low body weight and glucosuria were significant risk factors for renal dysfunction. We suggest close monitoring of renal function in patients with these risk factors even in resource-limited setting.

• Authors: Daisuke Mizushima, Junko Tanuma, Nguyen Thi Dung, Nguyen Hoai Dung, Nguyen Vu Trung, Nguyen Tien Lam, Hiroyuki Gatanaga, Yoshimi Kikuchi, Nguyen Van Kinh, Shinichi Oka
• Journal: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (J Infect Chemother) Vol. 20 Issue 12 Pg. 784-8 (Dec 2014) ISSN: 1437-7780 [Electronic] Netherlands
• PMID: 25301140 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014. Published by Elsevier Ltd.

Topics

• Adult
• Female
• HIV Infections (drug therapy, physiopathology)
• Humans
• Kaplan-Meier Estimate
• Kidney Diseases (physiopathology, virology)
• Male
• Prospective Studies
• Risk Factors
• Thinness (physiopathology, virology)
• Vietnam