Sage Journals: Discover world-class research

Abstract

Tenofovir-based antiretroviral therapy (TDF ART) is the first-line regimen for human immunodeficiency virus (HIV) in Africa. However, contemporary data on nephrotoxicity are lacking. We determined the renal outcomes of patients commenced on TDF ART in Malawi. ART-naïve patients initiated on TDF ART at a community health centre between 1 July 2013 and 31 December 2015 were included. The estimated glomerular filtration rate (eGFR, Cockcroft-Gault) was recorded at the initiation of therapy and over 18 months thereafter. The prevalence of renal impairment at ART initiation (eGFR < 60 ml/min) and the incidence of nephrotoxicity (eGFR < 50 ml/min) were determined. A total of 439 patients (median age: 32 years; 317 [72.2%] female) were included. Twenty-one (4.8%) patients had renal impairment at ART initiation; eGFR improved in all during follow-up. Nephrotoxicity occurred in 17 (4.0%) patients with eGFR > 50 ml/min at baseline, predominantly within the first six months of therapy. Increasing age and diastolic hypertension (>100 mmHg) were independent risk factors for nephrotoxicity development. The prevalence of kidney disease at ART initiation was 4.8% and nephrotoxicity occurred in 4.0%. Some eGFR decline may have been due to weight gain. Targeted monitoring of kidney function six months after TDF initiation should be considered in Malawi.

Keywords

Acute kidney injury chronic kidney disease tenofovir disoproxil fumarate HIV nephrotoxicity

Get full access to this article

View all access options for this article.

References

Gap report. UNAIDS, www.unaids.org/en/resources/campaigns/2014/2014gapreport/gapreport (accessed 1 August 2017).

Kharsany

ABM

Karim

QA.

HIV infection and AIDS in Sub-Saharan Africa: current status, challenges and opportunities. Open AIDS J 2016; 10: 34–48.

UNAIDS fact sheet. Latest statistics on the status of the AIDS epidemic, http://www.unaids.org/en/resources/fact-sheet (accessed 12 December 2017).

Hyle

Naidoo

et al . HIV, tuberculosis, and non-communicable diseases: what is known about the costs, effects, and cost-effectiveness of integrated care? J Acquir Immune Defic Syndr 1999 2014; 67: S87–S95.

Smit

et al . Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis 2015; 15: 810–818.

Mehta

et al . International Society of Nephrology’s 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet 2015; 385: 2616–2643.

Lameire

et al . Acute kidney injury: an increasing global concern. Lancet 2013; 382: 170–179.

Lewington

AJP

Cerdá

Mehta

RL.

Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int 2013; 84: 457–467.

Evans

RDR

et al . Incidence, aetiology and outcome of community-acquired acute kidney injury in medical admissions in Malawi. BMC Nephrol 2017; 18: 21.

10.

Tourret

Deray

Isnard-Bagnis

Tenofovir effect on the kidneys of HIV-infected patients: a double-edged sword?

J Am Soc Nephrol 2013; 24: 1519–1527.

11.

Clinical Management of HIV in Children and Adults – Malawi-HIV-Guidelines-2014.pdf, www.emtct-iatt.org/wp-content/uploads/2015/09/Malawi-HIV-Guidelines-2014.pdf (accessed 28 March 2016).

12.

Cockcroft

Gault

MH.

Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31–41.

13.

CKD Evaluation and Management – KDIGO, http://kdigo.org/guidelines/ckd-evaluation-and-management/. (accessed 17 June 2017).

14.

Campos

Ortiz

Soto

HIV and kidney diseases: 35 years of history and consequences. Clin Kidney J 2016; 9: 772–781.

15.

Wyatt

CM.

Kidney disease and HIV infection. Top Antivir Med 2017; 25: 13–16.

16.

Fernandez-Fernandez

et al . Tenofovir nephrotoxicity: 2011 update. AIDS Res Treat 2011; 2011: 354908.

17.

WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, www.who.int/hiv/pub/guidelines/arv2013/download/en/ (accessed 2 August 2017).

18.

Cooper

et al . Systematic review and meta-analysis: renal safety of tenofovir disoproxil fumarate in HIV-infected patients. Clin Infect Dis 2010; 51: 496–505.

19.

Mocroft

et al . Cumulative and current exposure to potentially nephrotoxic antiretrovirals and development of chronic kidney disease in HIV-positive individuals with a normal baseline estimated glomerular filtration rate: a prospective international cohort study. Lancet HIV 2016; 3: e23–e32.

20.

Glaser

et al . The prevalence of renal impairment in individuals seeking HIV testing in Urban Malawi. BMC Nephrol 2016; 17: 186.

21.

Johnson

et al . Tenofovir use and renal insufficiency among pregnant and general adult population of HIV-infected, ART-naïve individuals in Lilongwe, Malawi. Plos One 2012; 7: e41011.

22.

Struik

et al . The prevalence of renal impairment among adults with early HIV disease in Blantyre, Malawi. Int J STD Aids 2011; 22: 457–462.

23.

Reid

et al . Severe renal dysfunction and risk factors associated with renal impairment in HIV-infected adults in Africa initiating antiretroviral therapy. Clin Infect Dis 2008; 46: 1271–1281.

24.

Mulenga

et al . Effect of baseline renal function on tenofovir-containing antiretroviral therapy outcomes in Zambia. Clin Infect Dis 2014; 58: 1473–1480.

25.

Brennan

et al . Relationship between renal dysfunction, nephrotoxicity and death among HIV adults on tenofovir. AIDS 2011; 25: 1603–1609.

26.

De Waal

et al . Changes in estimated glomerular filtration rate over time in South African HIV-1-infected patients receiving tenofovir: a retrospective cohort study. J Int AIDS Soc 2017; 20: 1–8.

27.

Kamkuemah

Kaplan

Bekker

L-G

et al . Renal impairment in HIV-infected patients initiating tenofovir-containing antiretroviral therapy regimens in a primary healthcare setting in South Africa. Trop Med Int Health 2015; 20: 518–526.

28.

Bygrave

et al . Renal safety of a tenofovir-containing first line regimen: experience from an antiretroviral cohort in Rural Lesotho. Plos One 2011; 6: e17609.

29.

Chi

et al . Early clinical and programmatic outcomes with tenofovir-based antiretroviral therapy in Zambia. J Acquir Immune Defic Syndr 2010; 54: 63–70.

30.

Raimann

Riella

Levin

NW.

International Society of Nephrology’s 0by25 initiative (zero preventable deaths from acute kidney injury by 2025): focus on diagnosis of acute kidney injury in low-income countries. Clin Kidney J 2017; sfw134: https://doi.org/10.1093/ckj/sfw134

31.

Evans

et al.

Diagnostic performance of a saliva urea nitrogen dipstick to detect kidney disease in Malawi. Kidney Int Rep 2016; 2: 219–227.

32.

Wang

Yang

et al . The efficacy and safety of tenofovir alafenamide versus tenofovir disoproxil fumarate in antiretroviral regimens for HIV-1 therapy: meta-analysis. Medicine 2016; 95: e5146.

33.

Wyatt

et al . Estimating kidney function in HIV-infected adults in Kenya: comparison to a direct measure of glomerular filtration rate by iohexol clearance. Plos One 2013; 8: e69601.

34.

Botev

et al . Estimating glomerular filtration rate: Cockcroft–Gault and modification of diet in renal disease formulas compared to renal inulin clearance. Clin J Am Soc Nephrol 2009; 4: 899–906.

35.

Yuh

et al . Weight change after antiretroviral therapy and mortality. Clin Infect Dis 2015; 60: 1852–1859.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.57 MB

Renal outcomes in patients initiated on tenofovir disoproxil fumarate-based antiretroviral therapy at a community health centre in Malawi

Abstract

Keywords

Get full access to this article

References

Supplementary Material