Incidence and Factors associated with Tenofovir-induced nephrotoxicity in HIV infected patients in Nakornping Hospital
Keywords:
Nephrotoxicity, HIV, Tenofovir, Incidence, Risk FactorAbstract
Background :Tenofovir (TDF) is widely used as a component of first line antiretroviral regimens on the basis of its efficacy and tolerability in clinical trials. However, the use of TDF has been associated with nephrotoxicity.
The objective of this study was to evaluate the incidence and risk factors associated with TDF-induced nephrotoxicity among HIV-infected patients in Nakornping Hospital.
A retrospective cohort study was conducted on HIV-infected adult patients at the department of internal medicine Nakornping Hospital during January 2015 to December 2019. Data were extracted from electronic medical records. Nephrotoxicity was defined as > 25% decrease of baseline estimated glomerular filtration rate (eGFR). Risk factors were evaluated by multivariable logistic regression.
Of 1,960 HIV-infected patients included in this study, 1,135 were male (57.91%). The average age was 37.25 + 11.26 years. Nephrotoxicity was seen in 274 patients (13.98%). The median time to nephrotoxicity was 4.35 months (IQR=11.86).
Factors associated with nephrotoxicity were age > 50 years (Adj. OR=1.97, 95% CI 1.13-3.44, p=0.016), baseline CD4 less than 200 cell/mm3 (Adj. OR=6.36, 95% CI 3.90-10.36, p<0.001), pre-existing diabetes mellitus (Adj. OR=2.58, 95% CI 1.22-5.42, p=0.012) and ACEIs/ARB co-administered (Adj. OR=10.03, 95% CI 3.85-26.15, p<0.001).
TDF was associated with nephrotoxicity in HIV-infected patients. The significant risk factors for TDF-induced nephrotoxicity included age 50 and above, baseline CD4 lower than 200 cell/mm3, pre-existing diabetes mellitus and ACEIs/ARB. Patients treated with TDF, especially with risk factors should be monitored closely to prevent untoward adverse effect.
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