Abstract
IntroductionCurrent 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.MethodsWe 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.ResultsAmong 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.ConclusionIn this setting TDF-associated renal toxicity is rare and mainly transient. Further studies to assess TDF safety at lower CrCl thresholds are warranted.
Highlights
Current guidelines contraindicate TDF use when creatinine clearance (CrCl) falls below 50 ml/min
In 2009 the World Health Organisation revised its guidelines for antiretroviral therapy (ART) in resource-limited settings to recommend replacing stavudine with either tenofovir or zidovudine [1]
In this paper we report on program performance, early toxicity outcomes, prevalence of abnormal renal function at baseline, and factors associated with abnormal renal function from a community cohort in Lesotho
Summary
Current guidelines contraindicate TDF use when creatinine clearance (CrCl) falls below 50 ml/min. In 2009 the World Health Organisation revised its guidelines for antiretroviral therapy (ART) in resource-limited settings to recommend replacing stavudine with either tenofovir or zidovudine [1]. Clinical detection of renal impairment is difficult in resource-limited settings. Current international guidelines contraindicate TDF use when creatinine clearance (CrCl) falls below 50 ml/min unless dose reductions are made [6] and acknowledging the potential for nephrotoxicity, six-monthly monitoring of renal function is recommended by national guidelines [7]. If TDF is to be implemented in resource-limited settings where numbers requiring antiretroviral therapy are high but access to laboratory services are scarce, these monitoring protocols may need to be further simplified
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
