Incomplete Reversibility of Estimated Glomerular Filtration Rate Decline Following Tenofovir Disoproxil Fumarate Exposure


Jose, S; Hamzah, L; Campbell, LJ; Hill, T; Fisher, M; Leen, C; Gilson, R; Walsh, J; Nelson, M; Hay, P; Johnson, M; Chadwick, D; Nitsch, D; Jones, R; Sabin, CA; Post, FA; Study, UKCHC; (2014) Incomplete Reversibility of Estimated Glomerular Filtration Rate Decline Following Tenofovir Disoproxil Fumarate Exposure. The Journal of infectious diseases, 210 (3). pp. 363-373. ISSN 0022-1899 DOI: 10.1093/infdis/jiu107

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Abstract

Background. Tenofovir disoproxil fumarate (TDF) has been linked to renal impairment, but the extent to which this impairment is reversible is unclear. We aimed to investigate the reversibility of renal decline during TDF therapy. Methods. Cox proportional hazards models assessed factors associated with discontinuing TDF in those with an exposure duration of >6 months. In those who discontinued TDF therapy, linear piecewise regression models estimated glomerular filtration rate (eGFR) slopes before initiation of, during, and after discontinuation of TDF therapy. Factors associated with not achieving eGFR recovery 6 months after discontinuing TDF were assessed using multi-variable logistic regression. Results. We observed declines in the eGFR during TDF exposure (mean slopes, -15.7 mL/minute/1.73 m(2)/year [95% confidence interval {CI}, -20.5 to -10.9] during the first 3 months and -3.1 mL/minute/1.73 m(2)/year [95% CI, -4.6 to -1.7] thereafter) and evidence of eGFR increases following discontinuation of TDF therapy (mean slopes, 12.5 mL/minute/1.73 m(2)/year [95% CI, 8.9-16.1] during the first 3 months and 0.8 mL/minute/1.73 m(2)/year [95% CI,.1-1.5] thereafter). Following TDF discontinuation, 38.6% of patients with a decline in the eGFR did not experience recovery. A higher eGFR at baseline, a lower eGFR after discontinuation of TDF therapy, and more-prolonged exposure to TDF were associated with an increased risk of incomplete recovery 6 months after discontinuation of TDF therapy. Conclusions. This study shows that a decline in the eGFR during TDF therapy was not fully reversible in one third of patients and suggests that prolonged TDF exposure at a low eGFR should be avoided.

Item Type: Article
Keywords: Adenine, adverse effects, analogs & derivatives, therapeutic use, Adult, Anti-HIV Agents, adverse effects, therapeutic use, Cohort Studies, Drug Administration Schedule, Female, Glomerular Filtration Rate, drug effects, HIV Infections, drug therapy, Humans, Kidney Diseases, chemically induced, Male, Middle Aged, Organophosphonates, adverse effects, therapeutic use, Proportional Hazards Models, Viral Load
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Non-Communicable Disease Epidemiology
Faculty of Epidemiology and Population Health > Dept of Medical Statistics
PubMed ID: 24585896
Web of Science ID: 340242900005
URI: http://researchonline.lshtm.ac.uk/id/eprint/1924652

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