Patients infected with HIV and receiving tenofovir disoproxil fumarate (TDF) as antiretroviral therapy (ART) have an increased risk of estimated reduction in glomerular filtration rate if they have a low body weight; however, this risk is not significant according to a study published in the Journal of Infection .
Current World Health Organization recommendations suggest using TDF as part of initial ART for patients with HIV. TDF is also commonly used in combination for pre-exposure prophylaxis of HIV infection and as monotherapy for the treatment of hepatitis B virus infection.
Although high-potency antiretroviral therapy (ART) has dramatically improved survival in HIV-positive patients, chronic kidney disease remains a major comorbidity of HIV infection. The TDF regimen appears safe for short-term use in people with HIV, but it has been associated with a wide range of renal tubular dysfunction.
Furthermore, when combined with a boosted protease inhibitor, TDF is associated with an increased risk of estimated reduction in glomerular filtration rate, which could increase the long-term risk of chronic kidney disease.
However, the risk of eGFR reduction in Asian adults with HIV initiating TDF-containing ART remains unclear. Therefore, this study compared the long-term evolution of estimated glomerular filtration rate in Thai patients receiving TDF and zidovudine (AZT) and analyzed the role of body weight in the risk of eGFR reduction.
In total, data collected from a multicenter clinical trial in Thailand of 640 patients were included ( NCT001 6 2682 ). Of these patients, 461 (72%) received a regimen containing TDF for a mean duration of 6.7 years, and 179 (28%) received a regimen containing AZT for the same duration. The estimated glomerular filtration rate (eGFR) was estimated for each patient before ART initiation and quarterly. Using proportional hazards regression models, the risk of an estimated eGFR reduction >25% was compared in HIV-naive patients who initiated TDF or AZT without protease inhibitors.
Los resultados mostraron que el riesgo de una reducción estimada de la tasa de filtración glomerular > 25% no fue mayor en regímenes basados en TDF en comparación con AZT y, por lo tanto, no se asoció con el tratamiento (cociente de riesgos [HR], 1.11; P = .46 ) El análisis multivariante mostró que el riesgo de una reducción de la tasa de filtración glomerular estimada> 25% desde el inicio se asoció con el peso corporal al inicio (HR, 2,12; P <0,001); Esto también fue cierto para los pacientes con hipertensión (HR, 4.03; P <.001). Sin embargo, el efecto sobre el peso basal en> 25% de reducción estimada de la tasa de filtración glomerular no varió significativamente con el tratamiento ( P = .27).
Overall, the study authors concluded that "HIV-infected patients who initiated antiretroviral combinations containing TDF without protease inhibitors did not have an increased risk of reduced estimated glomerular filtration rate or chronic kidney disease compared with AZT-containing regimens in Thailand."
Reference
Liegeon G, Harrison L, Nechba A, et al. Long-term renal function in HIV-1 infected Asian adults receiving tenofovir disoproxil fumarate and no protease inhibitors [published online August 8, 2019] . J Infect . doi: 10.1016/j.jinf/2019.08.006