Abstract
ObjectiveTenofovir disoproxil fumarate (TDF) is a nucleotide analogue recommended in international HIV treatment guidelines. Purpose of this study was to estimate the long term effects of TDF on renal profile in a cohort of HIV patients in Ghana. Three hundred (300) consecutive HIV-positive patients who initiated TDF-based antiretroviral treatment in 2008 at the Korle-Bu Teaching Hospital were sampled. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault equation at baseline and renal impairment was defined as CrCl values of 30.0–49.9 mL/min (moderate renal impairment) and < 30 mL/min (severe renal impairment) as per institutional guidelines for renal function test.ResultsMedian follow up time was 2.9 years (IQR 2.3–3.4 years). At study endpoint, 63 participants (21.0% [95% CI 6.5–26.1]) recorded CrCl rate below 50 mL/min indicating incident renal impairment, made up of 18.3% moderate renal impairment and 2.3% severe renal impairment. Factors associated with incidence of renal impairment were increasing age, decrease in creatinine clearance rate at baseline, WHO HIV stage III/IV and participants with BMI of < 18.5 kg/m2. Patients with identified renal impairment risk factors at ART initiation should be targeted and monitored effectively to prevent renal injury.
Highlights
Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) are pertinent issues globally, more so in sub-Saharan Africa and in Ghana [1]
Factors associated with incidence of renal impairment were increasing age, decrease in creatinine clearance rate at baseline, World Health Organisation (WHO) HIV stage III/IV and participants with body mass index (BMI) of < 18.5 kg/m2
The Ghana Aids Commission in 2013 reported the prevalence of HIV to be 1.3% as against 3.6% in 1999 [2]. This significant reduction in prevalence could be attributed to the awareness created through the activities of the National AIDS/STI Control Program (NACP) and the benefits accruing from the life prolonging antiretroviral drugs (ARV), which reduces the degree of infectivity of HIV positive patients on subsidized or free highly active antiretroviral therapy (ART)
Summary
Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) are pertinent issues globally, more so in sub-Saharan Africa and in Ghana [1]. The Ghana Aids Commission in 2013 reported the prevalence of HIV to be 1.3% as against 3.6% in 1999 [2] This significant reduction in prevalence could be attributed to the awareness created through the activities of the National AIDS/STI Control Program (NACP) and the benefits accruing from the life prolonging antiretroviral drugs (ARV), which reduces the degree of infectivity of HIV positive patients on subsidized or free highly active antiretroviral therapy (ART). These ARVs are expected to be taken throughout the patient’s life time once the decision to initiate ART is made. Concerns regarding nephrotoxicity were initially raised by the structural similarity between tenofovir and the nephrotoxic acyclic nucleotide analogues adefovir and cidofovir
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