Renal safety of a tenofovir-containing first line regimen: experience from an antiretroviral cohort in rural Lesotho

• Published in: PloS one Vol. 6; no. 3; p. e17609
• Main Authors: Bygrave, Helen, Kranzer, Katharina, Hilderbrand, Katherine, Jouquet, Guillaume, Goemaere, Eric, Vlahakis, Nathalie, Triviño, Laura, Makakole, Lipontso, Ford, Nathan
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02.03.2011; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adenine - adverse effects; Adenine - analogs & derivatives; Adenine - pharmacology; Adult; Adults; AIDS; Algorithms; Analysis; Anti-Retroviral Agents - adverse effects; Anti-Retroviral Agents - pharmacology; Antiretroviral agents; Antiretroviral drugs; Biology; Body mass index; Cohort Studies; Collaboration; Creatinine; Creatinine - metabolism; Drug therapy; Epidemiology; Female; Follow-Up Studies; HIV; Hospitals; Human immunodeficiency virus; Humans; Impairment; Infectious diseases; Kidney - drug effects; Kidney Function Tests; Laboratories; Lesotho; Male; Medicine; Multivariate analysis; Organophosphonates - adverse effects; Organophosphonates - pharmacology; Pathogenesis; Patients; Program Evaluation; Renal function; Review boards; Risk analysis; Risk Factors; Rural Population; Safety; Tenofovir; Toxicity; Lesotho
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0017609

Current guidelines contraindicate TDF use when creatinine clearance (CrCl) falls below 50 ml/min. We report prevalence of abnormal renal function at baseline and factors associated with abnormal renal function from a community cohort in Lesotho. We calculated changes in CrCl from baseline for patients initiated on TDF at 6 and 12 months and the proportion of patients initiated on TDF who developed renal impairment. Screening algorithms were developed using risk factors determined by multivariate analysis. Among 933 adults for whom baseline creatinine was available, 176 (18.9%) presented with a baseline CrCl <50 ml/min. Renal function improved during follow-up. 19 patients who developed renal toxicity during follow up remained on TDF; renal function improved (CrCl≥50 ml/min) in all but 3 of these patients. Among 15 patients with a baseline CrCl <50 ml/min were started in error, none developed severe renal impairment. In this setting TDF-associated renal toxicity is rare and mainly transient. Further studies to assess TDF safety at lower CrCl thresholds are warranted.