Higher risk of renal impairment associated with tenofovir use amongst people living with HIV in India: A comparative cohort analysis between Western India and United Kingdom
BACKGROUND: Data on the renal safety of Tenofovir (TDF) in Low and Middle Income Countries (LMICs) is scarce. We compared development of various forms of renal impairment with use of TDF-containing antiretroviral therapy (ART) between a cohort from the Institute of Infectious Diseases (IID) Pune, We...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2014
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984028/ https://www.ncbi.nlm.nih.gov/pubmed/24679159 http://dx.doi.org/10.1186/1471-2334-14-173 |
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author | Pujari, Sanjay N Smith, Colette Makane, Abhimanyu Youle, Mike Johnson, Margaret Bele, Vivek Joshi, Kedar Dabhade, Digamber Bhagani, Sanjay |
author_facet | Pujari, Sanjay N Smith, Colette Makane, Abhimanyu Youle, Mike Johnson, Margaret Bele, Vivek Joshi, Kedar Dabhade, Digamber Bhagani, Sanjay |
author_sort | Pujari, Sanjay N |
collection | PubMed |
description | BACKGROUND: Data on the renal safety of Tenofovir (TDF) in Low and Middle Income Countries (LMICs) is scarce. We compared development of various forms of renal impairment with use of TDF-containing antiretroviral therapy (ART) between a cohort from the Institute of Infectious Diseases (IID) Pune, Western India and the Royal Free Hospital (RFH) London, UK. METHODS: This is a retrospective analysis of change in estimated glomerular filtration rates (eGFRs) at 6, 12 and 24 months post TDF initiation using the Modification of Diet in Renal Disease (MDRD) equation. In people living with Human Immunodeficiency virus (PLHIV) with pre-TDF eGFR > 90 ml/min/1.73 m(2) time to development of and factors associated with progression to eGFR < 60 ml/min/1.73 m(2) were calculated using standard survival methods. RESULTS: A total of 574 (59% Caucasian) at the RFH, and 708 (100% Indian ethnicity) PLHIV from IID were included. Baseline median eGFR were similar; RFH 102 (IQR 89, 117), IID 100 (82, 119). At 24 months, mean (SD) decline in eGFR was -7(21) at RFH (p < 0.0001) and -7(40) at IID (p = 0.001). Amongst those with pre-TDF eGFR > 90 ml/min/1.73 m(2) PLHIV at IID were more likely to develop an eGFR < 60 ml/min/1.73 m(2) (aHR = 7.6 [95% CI 3.4, 17.4] p < 0.0001) and had a faster rate of progression estimated using Kaplan Meier methods. Risk factors included age (per 10 years older: aHR = 2.21 [1.6, 3.0] p < 0.0001) and receiving concomitant ritonavir boosted Protease Inhibitor (PI/r) (aHR = 2.4 [1.2, 4.8] p = 0.01). CONCLUSIONS: There is higher frequency of treatment limiting renal impairment events amongst PLHIV receiving TDF in Western India. As TDF scale up progresses, programs need to develop capacity for monitoring and treatment of renal impairment associated with TDF. |
format | Online Article Text |
id | pubmed-3984028 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-39840282014-04-12 Higher risk of renal impairment associated with tenofovir use amongst people living with HIV in India: A comparative cohort analysis between Western India and United Kingdom Pujari, Sanjay N Smith, Colette Makane, Abhimanyu Youle, Mike Johnson, Margaret Bele, Vivek Joshi, Kedar Dabhade, Digamber Bhagani, Sanjay BMC Infect Dis Research Article BACKGROUND: Data on the renal safety of Tenofovir (TDF) in Low and Middle Income Countries (LMICs) is scarce. We compared development of various forms of renal impairment with use of TDF-containing antiretroviral therapy (ART) between a cohort from the Institute of Infectious Diseases (IID) Pune, Western India and the Royal Free Hospital (RFH) London, UK. METHODS: This is a retrospective analysis of change in estimated glomerular filtration rates (eGFRs) at 6, 12 and 24 months post TDF initiation using the Modification of Diet in Renal Disease (MDRD) equation. In people living with Human Immunodeficiency virus (PLHIV) with pre-TDF eGFR > 90 ml/min/1.73 m(2) time to development of and factors associated with progression to eGFR < 60 ml/min/1.73 m(2) were calculated using standard survival methods. RESULTS: A total of 574 (59% Caucasian) at the RFH, and 708 (100% Indian ethnicity) PLHIV from IID were included. Baseline median eGFR were similar; RFH 102 (IQR 89, 117), IID 100 (82, 119). At 24 months, mean (SD) decline in eGFR was -7(21) at RFH (p < 0.0001) and -7(40) at IID (p = 0.001). Amongst those with pre-TDF eGFR > 90 ml/min/1.73 m(2) PLHIV at IID were more likely to develop an eGFR < 60 ml/min/1.73 m(2) (aHR = 7.6 [95% CI 3.4, 17.4] p < 0.0001) and had a faster rate of progression estimated using Kaplan Meier methods. Risk factors included age (per 10 years older: aHR = 2.21 [1.6, 3.0] p < 0.0001) and receiving concomitant ritonavir boosted Protease Inhibitor (PI/r) (aHR = 2.4 [1.2, 4.8] p = 0.01). CONCLUSIONS: There is higher frequency of treatment limiting renal impairment events amongst PLHIV receiving TDF in Western India. As TDF scale up progresses, programs need to develop capacity for monitoring and treatment of renal impairment associated with TDF. BioMed Central 2014-03-29 /pmc/articles/PMC3984028/ /pubmed/24679159 http://dx.doi.org/10.1186/1471-2334-14-173 Text en Copyright © 2014 Pujari et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Pujari, Sanjay N Smith, Colette Makane, Abhimanyu Youle, Mike Johnson, Margaret Bele, Vivek Joshi, Kedar Dabhade, Digamber Bhagani, Sanjay Higher risk of renal impairment associated with tenofovir use amongst people living with HIV in India: A comparative cohort analysis between Western India and United Kingdom |
title | Higher risk of renal impairment associated with tenofovir use amongst people living with HIV in India: A comparative cohort analysis between Western India and United Kingdom |
title_full | Higher risk of renal impairment associated with tenofovir use amongst people living with HIV in India: A comparative cohort analysis between Western India and United Kingdom |
title_fullStr | Higher risk of renal impairment associated with tenofovir use amongst people living with HIV in India: A comparative cohort analysis between Western India and United Kingdom |
title_full_unstemmed | Higher risk of renal impairment associated with tenofovir use amongst people living with HIV in India: A comparative cohort analysis between Western India and United Kingdom |
title_short | Higher risk of renal impairment associated with tenofovir use amongst people living with HIV in India: A comparative cohort analysis between Western India and United Kingdom |
title_sort | higher risk of renal impairment associated with tenofovir use amongst people living with hiv in india: a comparative cohort analysis between western india and united kingdom |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984028/ https://www.ncbi.nlm.nih.gov/pubmed/24679159 http://dx.doi.org/10.1186/1471-2334-14-173 |
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