Title: Incidence of Tenofovir related Nephropathies in HIV Infected Patients: A Study from Tertiary Care Centre
Authors: Priyanka Gautam, Jitendra Kumar Doneria
DOI: https://dx.doi.org/10.18535/jmscr/v5i12.66
Abstract
Background: India has the third highest number of estimated people living with human immunodeficiency virus (HIV) in the world. Tenofovir (TDF) is an effective and widely used drug in treatment for both HIV and hepatitis B virus infection. Tenofovir is widely used in combination antiretroviral therapy including as a fixed dose combination pill. Several case reports and case series reported afterwards found tenofovir to be associated with nephropathy.
Aim: To study the incidence of tenofovir related nephropathies in HIV infected patients and to study the correlation of tenofovir induced nephrotoxicity with CD4 count.
Material and Methods: 200 patients on TDF based Antiretroviral therapy (ART) were included in hospital based prospective study based on inclusion and exclusion criteria. Baseline study variables serum creatinine value, urine-routine and microscopy, 24 hour urinary protein and CD4 count were recorded and patients were followed up for 6 months and study variables were compared. Statistical analysis were done by SPSS version 22.1.
Results: All patients had normal baseline renal function and urine routine and microscopic examination and were on tenofovir containing ART regimen. Mean age was 36.86 years and Sex ratio was 1.38:1. After six months of therapy 26 patients (13%) developed proteinuria. 20 patients (10%) had +1 proteinuria, 5 patients (2.5%) had +2 proteinuria and 1 patient (0.5%) had +3 proteinuria. Total 147 patients (73.5%) had weight gain and 53 patients (26.5%) had weight loss after taking tenofovir based ART for 6 months. Improvement in CD4 count was seen in 88.5% patients. Improvement in CD4 count was seen in 21 out of 26 patients having proteinuria. Decline in CD4 count was seen in total 11.5% patients. In this study, 12.5% patients had increase in creatinine levels and decrease in creatinine clearance was found in 13% patients.
Conclusion: Use of tenofovir based ART regimen is associated with increased incidence of nephropathy despite improvement in CD4 count and body weight significantly.
Keywords: Tenofovir, Nephropathy, HIV, CD4, ART.
References
- FuhrerJ, Satten GA, et al; Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection;HIV outpatient study investigators; N. Engl J Med 1998;338:853-60.
- Kumaraswamy N, Solomon S, Chauguturu S, Cecelia A, Flanigan T, Mayer KH; The changing natural history of HIV disease before and after the introduction of generic antiretroviral therapy in southern India; Clinical infectious disease 2005;1525-8.
- NACO (2014)’ Annual report 2013-2014; overview;1-2.
- NACO (2014)’ Annual report 2013-2014; introduction;11.
- Belongia EA, Costa J,Gareen IF, Grem JL, Inadomi JM, Kern ER, et al. NIH consensus development statement on management of hepatitis B. NIH Consens State Sci Statements. 2008;25(2):1–29.
- Gallant JE, Deresinski S. Tenofovir disoproxil fumarate. Clin Infect Dis. 2003;37:944–950.
- Cihlar T, Ho ES, Lin DC, Mulato AS. Human renal organic anion transporter 1 and its role in the nephrotoxicity of antiviral nucleotide analogs. Nucleosides Nucleotides Nucleic Acids.2001 Apr-Jul;20(4-7):641-8.
- WHO: Antiretroviral therapy for HIV infection in Adults and Adolescents; Geneva: World Health Organization, 2013/06/07 edition 2010.
- WHO: Consolidated Guidelines on the use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. Geneva: World Health Organization 2013.
- Wander GS, Pareek KK. Medicine update 2016. Jaypee Brothers 2016;26:905.
- Crum-Cianflone N, Ganesan A,Teneza-Mora N, Riddle M, Medina S, Barahona I, et al. Prevalence and Factors Associated with Renal Dysfunction Among HIV-Infected Patients. AIDS patient care and STDs. 2002;24:353-59
- Calzo L. Renal Toxicity Associated With Antiretroviral Therapy. HIV Clin Trials.2012 Jul-Aug;13(4):189-211.
- Nishijima T, Gatanaga H, Komatsu H, Tsukada K, Shimbo T, Aoki T et al. Renal function declines more in tenofovir- than abacavir-based antiretroviral therapy in low-body weight treatment-naive patients with HIV infection. PLoS One.2012;7(1):e29977.
- DeJesus E, Rockstroh JK, Henry K, Molina JM, Gathe J, Ramanathan S et al. Co-formulated elvitegravir, cobicistat, emtricitabine, and tenofovir disoproxil fumarate versus ritonavir-boosted atazanavir plus co-formulated emtricitabine and tenofovir disoproxil fumarate for initial treatment of HIV-1 infection: a randomised, double-blind, phase 3, non-inferiority trial. 2012 Jun 30;379(9835):2429-38.
- Fisher M, Moyle GJ, Shahmanesh M, Orkin C, Kingston M, Wilkins E et al. A randomized comparative trial of continued zidovudine/lamivudine or replacement with tenofovir disoproxil fumarate/emtricitabine in efavirenz-treated HIV-1-infected individuals. J Acquir Immune Defic Syndr. 2009 Aug 15;51(5):562-8.