Korean J Intern Med.  2019 Mar;34(2):409-417. 10.3904/kjim.2016.418.

Incidence and risk factors for tenofovir-associated nephrotoxicity among human immunodeficiency virus-infected patients in Korea

Affiliations
  • 1Division of Infectious Disease, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea. zzanmery@gmail.com
  • 2Division of Nephrology, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea.

Abstract

BACKGROUND/AIMS
Little is known about tenofovir disoproxil fumarate (TDF)-induced nephrotoxicity in human immunodeficiency virus (HIV)-infected patients in Korea. The objective of this study was to evaluate the incidence and risk factors of TDF-associated nephrotoxicity among HIV-infected patients in Korea.
METHODS
A single-center retrospective cohort study was conducted on HIV-infected patients in Korea. We included patients who had started TDF or abacavir (ABC)-based antiretroviral therapy (ART) between October 2006 and December 2014. Estimated glomerular filtration rate (eGFR) was estimated using the Chronic Kidney Disease-Epidemiology Collaboration equation. Renal dysfunction was defined as > 25% decrease of baseline eGFR. A propensity matched case-control study was conducted to compare renal dysfunction rates between the two groups. The risk factors of nephrotoxicity were analyzed by Cox regression analysis.
RESULTS
A total of 210 HIV-infected patients were included in the study, of which, 108 were TDF-based ART group and 102 were ABC-based ART group. Renal dysfunction occurred in 16 patients (14.8%) in the TDF group and 11 (10.8%) in the ABC group. Incidence of renal dysfunction of TDF and ABC group was 9.66 per 100 person-years (PYs) and 5.14 per 100 PYs, respectively (p = 0.176). In propensity-score-matched analysis, renal dysfunction rates were TDF 13.3% versus ABC 13.3% (p > 0.999). In multivariable analysis, Centers for Disease Control and Prevention clinical category C was a significant risk factor for renal dysfunction.
CONCLUSIONS
Approximately, 13% of HIV-infected patients treated with TDF had renal dysfunction. Advanced stage of HIV infection was a significant risk factor for renal dysfunction.

Keyword

Tenofovir; HIV-infected patients; Nephrotoxicity; Centers for Disease Control and Prevention clinical category C

MeSH Terms

Case-Control Studies
Centers for Disease Control and Prevention (U.S.)
Cohort Studies
Cooperative Behavior
Glomerular Filtration Rate
HIV
HIV Infections
Humans*
Incidence*
Kidney
Korea*
Retrospective Studies
Risk Factors*
Tenofovir
Tenofovir
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