1.Tenofovir-induced nephrotoxicity: A retrospective cohort study
The Medical Journal of Malaysia 2016;71(6):308-312
Background: Tenofovir (TDF) has been associated with renal
function deterioration, but local data regarding the incidence
and risk factors for this adverse event were lacking.
Objectives: To determine the incidence of nephrotoxicity in
HIV-infected patients on tenofovir-based regimens and to
evaluate risk factors involved in tenofovir-associated renal
function decline.
Methods: This is a single-centre retrospective cohort study
of 440 HIV-infected adults who were started on tenofovirbased
antiretroviral regimens. Data were extracted from
electronic medical and pharmacy records.
Results: A decline in eGFR of 25% or more was seen in 67
patients (15.2%) with an estimated incidence rate of 12 per
100 person-years. Among all 440 subjects, 22 discontinued
TDF-based therapy due to renal complication. From
multivariate analysis, the odds of developing >25% decrease
in eGFR with tenofovir-containing regimen was three times
higher for patients with baseline moderate renal impairment
(HR 3.19; 95% CI, 1.43-7.12; p=0.005) and 14 times higher for
patients with baseline severe renal impairment (HR 14.2;
95% CI, 11.20-170.7; p=0.036) as compared to those without
pre-existing renal insufficiency. Age above 50 years and CD4
cell count of less than 50 were significantly associated with
>25% decrement in eGFR.
Conclusion: The incidence rate of tenofovir-related renal
dysfunction was found to be 12 per 100 person-years. Preexisting
renal impairment, age 50 and above, and CD4 cell
count below 50 as were predictors for renal function decline.
Given that the use of tenofovir is escalating in Malaysia,
increased awareness about this adverse event is essential.
2.Static and dynamic prognostic factors for hepatitis-B-related acute-on-chronic liver failure.
Jung Min HA ; Won SOHN ; Ju Yeon CHO ; Jeung Hui PYO ; Kyu CHOI ; Dong Hyun SINN ; Geum Youn GWAK ; Moon Seok CHOI ; Joon Hyeok LEE ; Kwang Chul KOH ; Seung Woon PAIK ; Byung Chul YOO ; Yong Han PAIK
Clinical and Molecular Hepatology 2015;21(3):232-241
BACKGROUND/AIMS: Hepatitis-B-related acute-on-chronic liver failure has a poor prognosis. However, the advent of potent oral antiviral agents means that some patients can now recover with medical treatment. We aimed to identify the prognostic factors for hepatitis-B-related acute-on-chronic liver failure including the initial as well as the dynamically changing clinical parameters during admission. METHODS: Sixty-seven patients were retrospectively enrolled from 2003 to 2012 at Samsung Medical Center. The patients were classified into three categories: Recovery group (n=23), Liver transplantation group (n=28), and Death group (n=16). The Liver transplantation and Death groups were combined into an Unfavorable prognosis group. We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals. RESULTS: A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (> or =28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P=0.012), and the aggravation of hepatic encephalopathy during hospitalization (> or =grade III) (OR=15.41, P=0.013). Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group (P=0.016). CONCLUSIONS: Dynamic changes in clinical parameters during admission are useful prognostic factors for hepatitis-B-related acute-on-chronic liver failure.
Acute-On-Chronic Liver Failure/*diagnosis/drug therapy/etiology
;
Adult
;
Aged
;
Antibodies, Monoclonal, Murine-Derived/therapeutic use
;
Antineoplastic Combined Chemotherapy Protocols/therapeutic use
;
Antiviral Agents/therapeutic use
;
Cyclophosphamide/therapeutic use
;
DNA, Viral/analysis
;
Doxorubicin/therapeutic use
;
Female
;
Hepatitis B virus/genetics
;
Hepatitis B, Chronic/complications/*diagnosis/drug therapy
;
Hospitalization
;
Humans
;
Liver Transplantation
;
Male
;
Middle Aged
;
Multivariate Analysis
;
Odds Ratio
;
Prednisone/therapeutic use
;
Prognosis
;
Retrospective Studies
;
Severity of Illness Index
;
Vincristine/therapeutic use
;
Young Adult