Abstract
Background: Tenofovir disoproxil fumarate (TDF) is a major antiretroviral therapy for Thai human immunodeficiency virus (HIV) infected adults. TDF is associated with a decrease in renal function. There is limited data about the use of TDF with the incidence and time to renal impairment and chronic kidney disease (CKD) in Thai HIV-infected adults. Objectives: To study the association of TDF with the incidence rate and duration of renal impairment and CKD in Thai patients. Methods: A retrospective cohort study in Thai naïve HIV-infected adults was conducted to compare the incidence rate and time to renal impairment and CKD in TDF and non-TDF groups. The incidence rate was analyzed by person-time. Time to renal impairment and CKD were analyzed by Kaplan-Meier curves and log-rank tests. Results: A total of 1,400 patients were enrolled. The incidence rates of renal impairment in TDF and non-TDF groups were 27.66/1,000 and 5.54/1,000 person-years. The rate ratio was 4.99 (95% confidence interval [CI] 2.66–9.35). The incidence rates of CKD in both groups were not significantly different. Themean difference of eGFR between the TDF and non-TDF groups was 1.92 ml/min/1.73 m2 (p = 0.022). Time to onset of renal impairment between the TDF and non-TDF groups was found to differ by approximately 20 months. Conclusion: The incidence rate of renal impairment was about five times higher in the TDF group. A rapid decline of eGFR occurred in the first 2–3 years of treatment. Therefore, the renal function of HIV-infected patients should be monitored so that the severity of renal impairment could be evaluated and CKD could be prevented.
Highlights
Human immunodeficiency virus (HIV) infection is a major public health problem
Time to onset of renal impairment between the Tenofovir disoproxil fumarate (TDF) and non-TDF groups was found to differ by approximately 20 months
The result of a study reported that, after following human immunodeficiency virus (HIV)-infected patients who had an estimated glomerular filtration rate
Summary
Human immunodeficiency virus (HIV) infection is a major public health problem. In the U.S, there were patients with HIV (12.2%) who died from the renal disease between 1996 and 2006 [3]. In South Africa, patients with HIV who died from the renal disease increased to 67% between 1999 and 2006 [4]. The mortality rate from the renal disease has increased in patients with HIV in South America [5]. In the HIV-infected patient group with eGFR > 60 ml/min/1.73 m2, no mortality was detected [6]. Tenofovir disoproxil fumarate (TDF) is a major antiretroviral therapy for Thai human immunodeficiency virus (HIV) infected adults. There is limited data about the use of TDF with the incidence and time to renal impairment and chronic kidney disease (CKD) in Thai HIV-infected adults
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