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...

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Autores principales: Pujari, Sanjay N, Smith, Colette, Makane, Abhimanyu, Youle, Mike, Johnson, Margaret, Bele, Vivek, Joshi, Kedar, Dabhade, Digamber, Bhagani, Sanjay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
Materias:
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.
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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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