Tenofovir use is associated with a reduction in calculated glomerular filtration rates in the Swiss HIV Cohort Study
| Autor: | Heiner C. Bucher, Milos Opravil, Pietro Vernazza, Hansjakob Furrer, Luigia Elzi, Matthias Cavassini, Bernard Hirschel, Enos Bernasconi, Christoph A Fux, Marcel Wolbers, Mathew Simcock |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2007 |
| Předmět: |
Male
medicine.medical_specialty HIV Infections/ drug therapy Anti-HIV Agents Anti-HIV Agents/ pharmacology/therapeutic use Urology Organophosphonates Renal function HIV Infections Kidney Phosphonic Acids/ pharmacology/therapeutic use Cohort Studies Antiretroviral Therapy Highly Active medicine Clinical endpoint Humans Pharmacology (medical) Adverse effect Tenofovir Glomerular Filtration Rate/ drug effects Pharmacology ddc:616 business.industry Proportional hazards model Adenine Kidney/ drug effects/physiopathology Hazard ratio Hiv-1 Confidence interval Infectious Diseases Immunology Cohort HIV-1 Female business Adenine/ analogs & derivatives/pharmacology/therapeutic use Switzerland Cohort study Glomerular Filtration Rate |
| Zdroj: | Antiviral Therapy, Vol. 12, No 8 (2007) pp. 1165-1173 |
| ISSN: | 1359-6535 |
| Popis: | BackgroundA growing number of case reports have described tenofovir (TDF)-related proximal renal tubulopathy and impaired calculated glomerular filtration rates (cGFR). We assessed TDF-associated changes in cGFR in a large observational HIV cohort.MethodsWe compared treatment-naive patients or patients with treatment interruptions ≥12 months starting either a TDF-based combination antiretroviral therapy (cART) ( n=363) or a TDF-sparing regime ( n=715). The predefined primary endpoint was the time to a 10 ml/min reduction in cGFR, based on the Cockcroft-Gault equation, confirmed by a follow-up measurement at least 1 month later. In sensitivity analyses, secondary endpoints including calculations based on the modified diet in renal disease (MDRD) formula were considered. Endpoints were modelled using pre-specified covariates in a multiple Cox proportional hazards model.ResultsTwo-year event-free probabilities were 0.65 (95% confidence interval [CI] 0.58–0.72) and 0.80 (95% CI 0.76–0.83) for patients starting TDF-containing or TDF-sparing cART, respectively. In the multiple Cox model, diabetes mellitus (hazard ratio [HR]=2.34 [95% CI 1.24–4.42]), higher baseline cGFR (HR=1.03 [95% CI 1.02–1.04] by 10 ml/min), TDF use (HR=1.84 [95% CI 1.35–2.51]) and boosted protease inhibitor use (HR=1.71 [95% CI 1.30–2.24]) significantly increased the risk for reaching the primary endpoint. Sensitivity analyses showed high consistency.ConclusionThere is consistent evidence for a significant reduction in cGFR associated with TDF use in HIV-infected patients. Our findings call for a strict monitoring of renal function in long-term TDF users with tests that distinguish between glomerular dysfunction and proximal renal tubulopathy, a known adverse effect of TDF. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|