Change in Renal Function among HIV-Infected Koreans Receiving Tenofovir Disoproxil Fumarate-Backbone Antiretroviral Therapy: A 3-Year Follow-Up Study.
10.3349/ymj.2017.58.4.770
- Author:
Kyoung Hwa LEE
1
;
Ji Un LEE
;
Nam Su KU
;
Su Jin JEONG
;
Sang Hoon HAN
;
Jun Yong CHOI
;
Young Goo SONG
;
June Myung KIM
Author Information
1. Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. shhan74@yuhs.ac
- Publication Type:Original Article
- Keywords:
HIV;
anti-retroviral therapy;
tenofovir;
renal toxicity;
eGFR;
cystatin-C
- MeSH:
Creatinine;
Diet;
Follow-Up Studies*;
Glomerular Filtration Rate;
HIV;
HIV-1;
Humans;
Plasma;
Prospective Studies;
Retrospective Studies;
Tenofovir*
- From:Yonsei Medical Journal
2017;58(4):770-777
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Tenofovir disoproxil fumarate (TDF) is commonly prescribed as a fixed-dose, co-formulated antiretroviral drug for HIV-1 infection. The major concern of long-term TDF use is renal dysfunction. However, little is known about the long-term patterns of changes in renal function in HIV-infected Koreans receiving TDF. MATERIALS AND METHODS: We prospectively followed 50 HIV-infected Koreans, performing laboratory tests every 3 months during the first year and every 6 months for the next 2 years. Urine N-acetyl-β-D-glucosaminidase (NAG) and plasma cystatin-C were measured using samples collected in the first year. Data on renal function were retrospectively collected on HIV-infected patients receiving first-line TDF (n=40) and in antiretroviral therapy (ART)-naïve patients (n=24) for 3 years. Renal function was evaluated as estimated glomerular filtration rate (eGFR) from serum creatinine [Modification of Diet in Renal Disease (MDRD)] and cystatin-C. RESULTS: The eGFR (cystatin-C) showed significant changes from 0 to 48 wks (p=0.002), with the lowest levels at 24 wks (84.3±18.8 mL/min vs. 90.3±22.5 mL/min, p=0.021 by post hoc test). Urine NAG levels did not differ at 0, 12, 24, and 48 wks, although eGFR (MDRD) significantly decreased from 0 (98.7±18.9 mL/min/1.73 m²) to 144 wks (89.0±14.7 mL/min/1.73 m²) (p=0.010). The first-line TDF group had significantly lower eGFR (MDRD) than the ART-naïve group at 144 wks (89.7 mL/min/1.73 m² vs. 98.4 mL/min/1.73 m², p=0.036). Thirteen (26%) participants experienced a decrease in renal impairment of 10 mL/min/1.73 m² in eGFR (MDRD) at 144 wks. CONCLUSION: These data suggest that clinically meaningful renal injury can develop in HIV-infected Koreans receiving long-term TDF.
