A study of renal dysfunction among HIV-infected patients on tenofovir based ART regimen in the Northeast part of India

Authors

  • Lourembam Gayatri Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
  • Nang N. Manpang Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
  • Duyu Nobing Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
  • Dhanaraj S. Chongtham Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
  • M. Bijoy Singh Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
  • Sudhangshu Mazumdar Department of Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20203075

Keywords:

Antiretroviral, Creatinine clearance, Renal dysfunction, Tenofovir

Abstract

Background: Tenofovir is an integral part of the currently used antiretroviral therapy (ART) regime. However, nephrotoxicity has been a concern. This study has been undertaken to evaluate the prevalence and risk factors of renal dysfunction among HIV-patients on tenofovir containing ART regime.

Methods: This cohort study was conducted at Regional Institute of Medical Sciences. HIV-patients newly started on tenofovir containing ART regime were subjected to detailed history, thorough physical examination, and routine investigations. Serum creatinine levels and creatinine clearance were measured at regular intervals.

Results: Mean age of the patients was 42.37±10.8 years. Most of the patients had normal BMI (66%) and 22% were obese while 12% of the cases were underweight. Majority of the patients had CD4 count less than 350 cells/cumm. Renal dysfunction, defined as creatinine clearance <50 ml/min, developed in 9% of the patients at 3 months and in 33% of the patients at 6 months. Old age, low CD4 cell count, HCV co-infection, and advanced HIV infection were found to be important risk factors.

Conclusions: Development of renal dysfunction is common among HIV patients receiving tenofovir-based ART regimen. Old age, low CD4 cell count, HCV co-infection, and advanced HIV infection were found to be important risk factors.

References

Crum NF, Riffenburgh RH, Wegner S, Agan BK, Tasker SA, Spooner KM, et al. Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. JAIDS. 2006 Feb 1;41(2):194-200.

Szczech LA, Gange SJ, Van Der Horst C, Bartlett JA, Young M, Cohen MH, et al. Predictors of proteinuria and renal failure among women with HIV infection. Kidney Inter. 2002 Jan 1;61(1):195-202.

Gupta SK, Mamlin BW, Johnson CS, Dollins MD, Topf JM, Dube MP. Prevalence of proteinuria and the development of chronic kidney disease in HIV-infected patients. Clin Nephrol. 2004 Jan;61(1):1-6.

Gardner LI, Holmberg SD, Williamson JM, Szczech LA, Carpenter CC, Rompalo AM, et al. Development of proteinuria or elevated serum creatinine and mortality in HIV-infected women. J Acquir Immune Defic Syndr. 2003;32:203-9.

Szczech LA, Hoover DR, Feldman JG, Cohen MH, Gange SJ, Goozé L, et al. Association between renal disease and outcomes among HIV-infected women receiving or not receiving antiretroviral therapy. Clin Infect Dis. 2004;39:1199-206.

Roling J, Schmid H, Fischereder M, Draenert R, Goebel FD. HIV-Associated Renal Diseases and Highly Active Antiretroviral Therapy-Induced Nephropathy. Clin Infect Dis. 2006;42:1488-95.

Reites MG, Verbagen DW. Stable Improvement of Renal Function after Initiation of Highly Active Antiretroviral Therapy in Patients with HIV-1-associated Nephropathy. Nephrol Dial Transplant. 2002;17:1836-39.

Moreno-Cuera VJ, Morales-Conejo M, Rubio R. Antiretroviral treatment associated life-threatening adverse events. Med Clin. 2006;126(19):744-9.

Jiménez-Nácher I, García B, Barreiro P, Rodriguez-Novoa S, Morello J, Gonzalez-Lahoz J, et al. Trends in the prescription of antiretroviral drugs and impact on plasma HIV-RNA measurements. J Antimicrob Chemother. 2008;62:816-22.

Pajare AR. Evolution of anti-retroviral therapy: multiple pills to fixed drug combinations. J Assoc Physicians India. 2015 Aug;63:11-3.

Lin J, Denker BM. Azotemia and Urinary Abnormalities. In: Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J, editors. Harrison’s Principles of Internal Medicine. 19th ed. New York: Mc Graw Hill; 2015:291.

Mugomeri E, Olivier D, Van den Heever WM. The effect of Tenofovir on renal function in HIV-positive patients in Lesotho: peer reviewed original article. Med Tech SA 2014;28(1):34-7.

Lee KH, Lee JU, Ku NS, Jeong SJ, Han SH, Choi JY et al. Changes in renal function among HIV-infected Koreans receiving tenofovir disoproxil fumarate-backbone antiretroviral therapy: a 3 year follow-up study. Yonsei Med J. 2017 Jul;58(4):770-7.

Patel KK, Patel AK, Ranjan RR, Patel AR, Patel JK. Tenofovir-associated renal dysfunction in clinical practice: An observational cohort from western India. Indian J Sex Transm Dis. 2010;31:30-4.

Wikman P, Safont P, Palacio MD, Moreno A, Moreno S, Casado JL. The significance of antiretroviral-associated acute kidney injury in a cohort of ambulatory HIV-infected patients. Nephrol Dial Transplant. 2013;28(8):2073-81.

Huang YS, Chan CK, Tsai MS, Lee KY, Lin SW, Chang SY, et al. Kidney dysfunction associated with tenofovir exposure in human immunodeficiency virus-1-infected Taiwanese patients. J Microbiol Immunol Infect. 2015 Sep;48:256-62.

Koh HM, Kumar S. Tenofovir-induced nephrotoxicity: a retrospective cohort study. Med J Malaysia. 2016 Dec;71(6):308-12.

Rungtivasuwan K, Avihingsanon A, Thammajaruk N, Mitruk S, Burger DM, Ruxrungtham K, et al. Influence of ABCC2 and ABCC4 polymorphisms on tenofovir plasma concentrations in Thai HIV-infected patients. Antimicrob Agents Chemother 2015 Jun;59(6):3240-5.

Brennan A, Evans D, Maskew M, Naicker S, Ive P, Sanne I, Maotoe T, et al. Relationship between renal dysfunction, nephrotoxicity and death among HIV adults on tenofovir. AIDS (London, England). 2011 Aug 24;25(13):1603.

Wantakish E, Chongwe G, Munkombwe D, Michelo C. Renal dysfunction among HIV-infected patients on tenofovir-based antiretroviral therapy at Ronald ross hospital in Zambia. J AIDS Clin Res. 2017 Jan;8(1):651-8.

Waheed S, Attia D, Estrella MM, Zafar Y, Atta MG, Lucas GM, et al. Proximal tubular dysfunction and kidney and kidney injury associated with tenofovir in HIV patients: a case series. Clin Kidney J. 2015 Aug;8(4):420-5.

Sadre A, Munshi N, Dhande S, Dravid A. Tenofovir-induced acute kidney injury in HIV-infected patients in western India: a resource limited setting perspective. J Int AIDS Soc. 2012;15(4):43-9.

Downloads

Published

2020-07-21

Issue

Section

Original Research Articles