Renal Safety of a Tenofovir-Containing First Line Regimen: Experience from an Antiretroviral Cohort in Rural Lesotho

PLoS One

Guillaume Jouquet¹  Katharina Kranzer²  Katherine Hilderbrand³  Nathalie Vlahakis³  Lipontso Makakole⁴  Eric Goemaere⁴  Laura Triviño⁴  Helen Bygrave⁴  Nathan Ford⁵ 

[1] Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Rondebosch, South Africa;London School of Hygiene and Tropical Medicine, London, United Kingdom;Médecins Sans Frontières, Cape Town, South Africa;Médecins Sans Frontières, Morija, Lesotho;Scott Hospital, Morija, Lesotho

关键词: Creatinine;    Renal system;    Toxicity;    Antiretroviral therapy;    Algorithms;    Government laboratories;    Multivariate analysis;    Primary care;   

DOI  :  10.1371/journal.pone.0017609

学科分类：医学（综合）

来源: Public Library of Science

【 摘 要 】

Introduction Current guidelines contraindicate TDF use when creatinine clearance (CrCl) falls below 50 ml/min. We report prevalence of abnormal renal function at baseline and factors associated with abnormal renal function from a community cohort in Lesotho. Methods We calculated changes in CrCl from baseline for patients initiated on TDF at 6 and 12 months and the proportion of patients initiated on TDF who developed renal impairment. Screening algorithms were developed using risk factors determined by multivariate analysis. Results Among 933 adults for whom baseline creatinine was available, 176 (18.9%) presented with a baseline CrCl <50 ml/min. Renal function improved during follow-up. 19 patients who developed renal toxicity during follow up remained on TDF; renal function improved (CrCl≥50 ml/min) in all but 3 of these patients. Among 15 patients with a baseline CrCl <50 ml/min were started in error, none developed severe renal impairment. Conclusion In this setting TDF-associated renal toxicity is rare and mainly transient. Further studies to assess TDF safety at lower CrCl thresholds are warranted.

【 授权许可】

CC BY