Risk factors of receiving tenofovir related to renal Insufficiency in patients


  • Maythaporn Bumrungsawat Department of Preventive and Social medicine Faculty of Medicine Siriraj hospital Mahidol University
  • Winai Ratanasuwan Department of Preventive and Social medicine Faculty of Medicine Siriraj hospital Mahidol University
  • Mathuros Tipayamongkholgul Department of Epidemiology Faculty of Public health Mahidol University
  • Nuttasith Larpparisuth Department of Medicine Faculty of Medicine Siriraj hospital Mahidol University


Antiretroviral therapy, Tenofovir, Renal insufficiency


     Tenofovir was an antiviral drug to use for the treatment of HIV infection with its side effects on the kidneys of HIV-infected patients. This study aimed to study other relevant risk factors for the incidence of the renal insufficiency in HIV patients were aged ≥ 18 years who had registered and ever received tenofovir-based regimen at Infectious Diseases and Immunodeficiency Clinic of Siriraj hospital and Medical Outpatient Department of Bamrasnaradura Infectious Diseases Institute between 1st January 2005 and 30th June 2011 with a retrospective cohort study to perform at least 72 months. The total subjects of this study included 241 subjects. The follow-up time was 13.71 100PYs; 41 showed renal insufficiency and 2.99 per 100PYs of incidence rate. After multivariate adjustment for other factors in TDF group by Cox proportional hazards models, HIV patients who had received other ARV drugs before follow-up had a 3.126 fold greater risk for renal insufficiency than those who had not received other ARV drugs before follow-up (Hazard ratio = 3.126, 95% CI for HR 1.380-7.083, P-value = 0.006).

     The results of this study supported other studies in related fields which found that to receive ARV drugs prior to enrollment for this research was associated with the incidence of renal insufficiency. Moreover, the most rapid period of renal insufficiency occurrence was approximately 5.8 months which was considered to be relatively fast.

     Therefore, use of ARV drugs should be closely monitored for renal function and other factors gained from the statistical analysis, but no findings associated with this study should not be overlooked in the clinical treatment. The results of this study will be beneficial to HIV-infected patients as well as to hospitals to utilize them for planning the public health policy to reduce the complications causing the incidence of renal toxicity by ARV drugs usage.


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1. World Health Organization. Number of people (all ages) living with HIV [Internet]. 2019 [Cited 2020 Oct 18]. Available from: https://www.who.int/data/gho/data/themes/topics/indicator-groups/indicator-group-details/GHO/number-of-people-(all-ages)-living-with-hiv
2. World Health Organization. Estimated antiretroviral therapy coverage among people living with HIV (%) [Internet] 2019. [Cited 2020 Oct 18]. Available from: https://www.who.int/data/gho/data/indicators/indicator-details/GHO/estimated-antiretroviral-therapy-coverage-among-people-living-with-hiv-(-)
3. สำนักโรคเอดส์ วัณโรค และโรคติดต่อทางเพศสัมพันธ์ ศูนย์พัฒนาระบบบริการยาต้านไวรัสสำหรับผู้ติดเชื้อเอช ไอวีและผู้ป่วยเอดส์ในประเทศไทย กรมควบคุมโรค. แนวทางการตรวจรักษาและป้องกันการติดเชื้อเอชไอวี ประเทศไทย ปี 2549/2550. กรุงเทพฯ: โรงพิมพ์ชุมนุมสหกรณ์การเกษตรแห่งประเทศไทย; 2550.
4. Nishijima T, Komatsu H, Gatanaga H, Aoki T, Watanabe K, Kinai E, et al. Impact of small body weight on tenofovir-associated renal dysfunction in HIV-infected patients: a retrospective cohort study of Japanese patients. PloS one 2011;6(7):e29977
5. Kyaw NT, Harries AD, Chinnakali P, Antierens A, Soe KP, Woodman M, et al. Low Incidence of Renal Dysfunction among HIV-Infected Patients on a Tenofovir-Based First Line Antiretroviral Treatment Regimen in Myanmar. PloS one 2015;10(8):e0135188
6. เกศรินทร์ ชัยศิริ. ความเป็นพิษต่อไตจากการใช้ยาทีโนโฟเวียร์ในผู้ติดเชื้อเอชไอวี. [วิทยานิพนธ์ปริญญาเภสัชศาสตรมหาบัณฑิต]. กรุงเทพฯ: จุฬาลงกรณ์มหาวิทยาลัย; 2552.
7. Pujari SN, Smith C, Makane A, Youle M, Johnson M, Bele V, et al. 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. BMC Infectious Diseases 2014;173(14):1-7.
8. Scherzer R, Estrella M, Li Y, Choi AI, Deeks SG, Grunfeld C, et al. Association of tenofovir exposure with kidney disease risk in HIV infection. AIDS (London, England) 2012;26(7):867-75.
9. Woratanarat K, Kanjanabuch T, Suankratay C. Tenofovir disoproxil fumarate-associated nephrotoxicity in HIV-infected patients: a prospective controlled study. The Journal of the Medical Association of Thailand. 2013; 96(4):432-9.
10. Gallant JE, Moore RD. Renal function with use of a tenofovir-containing initial antiretroviral regimen. AIDS (London, England). 2009; 23(15):1971-5.
11. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Annals of Internal Medicine 2009;150(9):604-12.
12. วิศิษฎ์ ตันหยง, พีรยศ ภมรศิลปะธรรม, ฉัตชัย ฉิ่นไพศาล. ทีโนโฟเวียร์และพิษต่อไตระดับเซลล์. วารสารวิทยาศาสตร์บูรพา 2560;22(2):248-59.
13. Gallant JE, Parish MA, Keruly JC, Moore RD. Changes in renal function associated with tenofovir disoproxil fumarate treatment, compared with nucleoside reverse-transcriptase inhibitor treatment. Clinical Infectious Diseases 2005;40(8):1194-8.
14. Gallant JE, Staszewski S, Pozniak AL, DeJesus E, SuleimanJM, Miller MD, et al. Efficacy and safety of tenofovir DF vs stavudine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial. JAMA: The Journal of the American Medical Association 2004;292(2):191-201.
15. Rodriguez-Novoa S, Labarga P, D'Avolio A, Barreiro P, Albalate M, Vispo E, et al. Impairment in kidney tubular function in patients receiving tenofovir is associated with higher tenofovir plasma concentrations. AIDS 2010;24(7):1064-6.
16. Verhelst D, Monge M, Meynard JL, Fouqueray B, Mougenot B, Girard PM, et al. Fanconi syndrome and renal failure induced by tenofovir: a first case report. American Journal of Kidney Diseases 2002;40(6):1331-3.
17. Del Palacio M, Romero S, Casado JL. Proximal tubular renal dysfunction or damage in HIV-infected patients. AIDS Reviews 2012;14(3):179-87.
18. Gitman MD, Hirschwerk D, Baskin CH, Singhal PC. Tenofovir-induced kidney injury. Expert Opinion on Drug Safety 2007;6(2):155-64.
19. Herlitz LC, Mohan S, Stokes MB, Radhakrishnan J, D'Agati VD, Markowitz GS. Tenofovir nephrotoxicity: acute tubular necrosis with distinctive clinical, pathological, and mitochondrial abnormalities. Kidney International 2010;8(11):1171-7.
20. Lyseng-Williamson KA, Reynolds NA, Plosker GL. Tenofovir disoproxil fumarate: a review of its use in the management of HIV infection. Drugs 2005;65(3):413-32.
21. Ray AS, Cihlar T, Robinson KL, Tong L, Vela JE, Fuller MD, et al. Mechanism of active renal tubular efflux of tenofovir. Antimicrobial Agents and Chemotherapy 2006;50(10):3297-304.
22. Nishijima T, Gatanaga H, Komatsu H, Tsukada K, Shimbo T, Aoki T, et al. Renal function declines more in tenofovir- than abacavir-based antiretroviral therapy in low-body weight treatment-naive patients with HIV infection. PloS one 2012;7(1):e29977.
23. Hall AM, Hendry BM, Nitsch D, Connolly JO. Tenofovir-associated kidney toxicity in HIV-infected patients: a review of the evidence. American Journal of Kidney Diseases 2011;57(5):773-80.
24. Nishijima T, Kawasaki Y, Tanaka N, Mizushima D, Aoki T, Watanabe K, et al. Long-term exposure to tenofovir continuously decrease renal function in HIV-1-infected patients with low body weight: results from 10 years of follow-up. AIDS (London, England) 2014;28(13):1903-10.
25. Chaisiri K, Bowonwatanuwong C, Kasettratat N, Kiertiburanakul S. Incidence and risk factors for tenofovir-associated renal function decline among Thai HIV-infected patients with low-body weight. Current HIV Research 2010;8(7):504-9.
26. Gervasoni C, Meraviglia P, Landonio S, Baldelli S, Fucile S, Castagnoli L, et al. Low body weight in females is a risk factor for increased tenofovir exposure and drug-related adverse events. PloS One 2013;8(12):e80242.
27. Goicoechea M, Liu S, Best B, Sun Shelly, Jain S, Kemper C, et al. Greater tenofovir-associated renal function decline with protease inhibitors-based versus nonnucleoside reverse-transcriptase inhibitors-based therapy. The Journal of Infectious Diseases 2008;197(1):102-8.
28. Huang YS, Chan CK, Tsai MS, Lee KY, Lin SW, Chang SY, et al. Kidney dysfunction associated with tenofovir exposure in human immunodeficiency virus-1-infected Taiwanese patients. Journal of Microbiology, Immunology and Infection 2017;50:595-603.
29. Suzuki S, Nishijima T, Kawasaki Y, Kurosawa T, Mutoh Y, Kikuchi Y, et al. Effect of tenofovir disoproxil fumarate on incidence of chronic kidney disease and rate of estimated glomerular filtration rate decrement in HIV-1-infected treatment-Naive Asian Patients: results from 12-year observational cohort. AIDS Patient Care and STDs 2017;31(3):105-12.
30. Nelson MR, Katlama C, Montaner JS, Cooper DA, Gazzard B, Clotet B, et al. The safety of tenofovir disoproxil fumarate for the treatment of HIV infection in adults: the first 4 years. AIDS 2007;21(10):1273-81.
31. Cassetti I, Madruga JV, Suleiman JM, Etzel A, Zhong L, Cheng AK, et al. The safety and efficacy of tenofovir DF in combination with lamivudine and efavirenz through 6 years in antiretroviral-naïve HIV-1 Infected patients. HIV Clinical Trials 2007;8(3):164-72.



How to Cite

Bumrungsawat เ, Ratanasuwan ว, Tipayamongkholgul ม, Larpparisuth น. Risk factors of receiving tenofovir related to renal Insufficiency in patients. JPMAT [Internet]. 2021 Jan. 12 [cited 2022 Aug. 14];10(3):366-82. Available from: https://he01.tci-thaijo.org/index.php/JPMAT/article/view/247072



Original Article