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AIDS Res Ther. 2012; 9: 19.
Published online Jun 15, 2012. doi:  10.1186/1742-6405-9-19
PMCID: PMC3443451
Renal safety of tenofovir containing antiretroviral regimen in a Singapore cohort
Arlene C Chua,corresponding author1 Ryan M Llorin,1 Kelvin Lai,2 Philippe Cavailler,3 and Hwa Lin Law2
1Department of Infectious Disease, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
2Department of Pharmacy, Tan Tock Seng Hospital, 11 Jalan, Tan Tock Seng, Singapore, 308433, Singapore
3Department of Epidemiology Research, Regional Emerging Diseases Intervention Centre, 10 Biopolis Road #02-01, Singapore, 138670, Singapore
corresponding authorCorresponding author.
Arlene C Chua: Arlene_CHUA/at/ttsh.com.sg; Ryan M Llorin: Llorin_Ryan_Marte/at/ttsh.com.sg; Kelvin Lai: Kelvin_LAI/at/ttsh.com.sg; Philippe Cavailler: PCavailler/at/redi.org.sg; Hwa Lin Law: Hwa_Lin_LAW/at/ttsh.com.sg
Received January 10, 2012; Accepted May 15, 2012.
Abstract
Background
Tenofovirdisoproxilfumarate (TDF) is a nucleotide analogue widely recommended in international HIV treatment guidelines. The association of TDF and renal dysfunction has remained an area of interest.
Findings
We conducted a retrospective review of all patients on TDF from July 2007 to December 2009 in our institution and evaluated their renal function. Absolute change of creatinine clearance (CLCr) using Cockroft-Gault equation from baseline was calculated at 6, 12, 18 and 24 months. Overall, 226 patients were included in the study. Ninety percent were male. The median age was 46 yrs old (23–82), median weight was 60 kg (IQR 53.75-68), median CD4 count was 127 cells/mm3 (IQR 38–258) and median CLCr 82.7 mL/min (IQR 71.4-101.7) on initiation of TDF. The median decline of CLCr from baseline was −3.9 ml/min (IQR −12.3 to 7.6), and −3.6 ml/min (IQR −12.4 to 6.7) at 12 (n = 102), 24 months (n = 75) respectively. Eighteen of 226 patients had a decline in renal function to </=50 ml/min. Majority of which had an improvement of CLCr on follow up. Only 80% of patients ever received monitoring of renal function.
Conclusion
While we noted renal toxicity to be rare and transient among our cohort receiving TDF as part of their ARV regimen, these results reflect the short term renal effects of TDF given that ARV treatment is lifelong. Given that laboratory monitoring may be difficult to implement in many situations, future prospective studies looking into an evidence based algorithm for less frequent renal function monitoring than current guideline recommendations may be helpful.
Keywords: Tenofovir, Kidney, Antiretrovirals
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