Abstract
BackgroundWHO recommends using Tenofovir containing first line antiretroviral therapy (ART), however, Tenofovir has been reported to be associated with renal impairment and dysfunction. We compared renal function among individuals on Tenofovir and those on non-Tenofovir containing ART.MethodsIn a cross-sectional study of HIV-Positive adults on ART, at enrolment into a prospective cohort to study the long-term complications of ART in Uganda, information on biophysical measurements, medical history, clinical examination and renal function tests (RFTs) was collected. Fractional Tubular phosphate reabsorption and estimated glomerular filtration rate (eGFR) were calculated. Mean values of RFTs and proportions with abnormal RFTs were compared between non-Tenofovir containing (Non-TDF) and Tenofovir containing (TDF-ART) ART regimen groups using a general linear regression model. Durations of TDF exposure were also compared.ResultsBetween July 2013 and October 2014, we enrolled 953 individuals on ART for 6 or more months, median duration on ART was 9.3 years, 385 (40.4 %) were on non-TDF and 568 (59.6 %) on TDF-ART regimens. The proportion of participants with Proteinuria (>30 mg/dl) was higher among the TDF-ART group than the non-TDF ART group. However, in multivariable analysis, there were no significant differences in the adjusted mean differences of eGFR, serum urea, serum creatinine, fractional tubular reabsorption of phosphate and serum phosphates when patients on TDF-ART were compared with those on non-TDF containing ART. There were no differences in renal function even when different durations on Tenofovir were compared.ConclusionsWe found no differences in renal function among patients on Tenofovir and non-Tenofovir containing ART for almost a decade. Tenofovir based first line ART can therefore safely be initiated even in settings without routine renal function monitoring.
Highlights
World Health Organisation (WHO) recommends using Tenofovir containing first line antiretroviral therapy (ART), Tenofovir has been reported to be associated with renal impairment and dysfunction
Glomerular function The overall proportions with renal dysfunction or renal failure and abnormal renal function assessment parameters were low among our study participants
In the unadjusted analysis, the mean estimated glomerular filtration rate (eGFR) was lower among the Tenofovir Disoproxil Fumarate (TDF)-ART group than the non-TDF ART group using the Chronic Kidney Disease Epidemiology (CKD-Epi) formula (P = 0.001) and Modified Diet in Renal Disease (MDRD) formula with race adjustment (P = 0.008), but we found no differences in the mean eGFR calculated using the Cockcroft-Gault formulae
Summary
WHO recommends using Tenofovir containing first line antiretroviral therapy (ART), Tenofovir has been reported to be associated with renal impairment and dysfunction. In the DART Trial, there were no significant differences in the incidence of severe decline in eGFR between patients on Tenofovir containing and other ART regimens up to 4 years of therapy. A review on the renal safety of Tenofovir among HIVpositive patients showed no evidence that Tenofovir use increased the risk of severe proteinuria, hypophosphatemia nor reduced eGFR [21]. Most of these studies reported on short to mid-term Tenofovir associated renal toxicity, and not the renal dysfunction associated with the long-term use of Tenofovir
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