TY - JOUR
T1 - Incomplete reversibility of eGFR following tenofovir exposure
AU - on behalf of the UK Collaborative HIV Cohort Study Steering Committee
AU - Jose, Sophie
AU - Hamzah, Lisa
AU - Campbell, Lucy
AU - Hill, Teresa
AU - Fisher, Martin
AU - Leen, Clifford
AU - Gilson, Richard
AU - Walsh, John
AU - Nelson, Mark
AU - Hay, Phillip
AU - Johnson, Margaret
AU - Chadwick, David
AU - Nitsch, Dorothea
AU - Jones, Rachael
AU - Sabin, Caroline
AU - Post, Frank
N1 - The study is funded by the Medical Research Council, UK (grant numbers G0000199, G0600337 and G0900274).
PY - 2014/2/28
Y1 - 2014/2/28
N2 - Background. Tenofovir disoproxil fumarate (TDF) has been linked to renal impairment but the extent to which this impairment is reversible is unclear. We aimed to investigate the reversibility of renal decline on TDF.Methods. Cox Proportional Hazards models assessed factors associated with discontinuing TDF in those with >6 months exposure. In those who discontinued TDF, linear piecewise regression models estimated eGFR slopes (mL/min/1.73 m(2)/yr) before, during and after TDF exposure. Factors associated with not achieving eGFR recovery 6 months after discontinuing TDF were assessed using multivariable logistic regression.Results. We observed eGFR declines during TDF exposure (mean (95% CI) slopes -15.7 (-20.5, -10.9) during the first 3 months; -3.1(-4.6, -1.7) thereafter), and evidence of eGFR increases following discontinuation (12.5 (8.9, 16.1) during the first 3 months; 0.8 (0.1, 1.5) thereafter). Following TDF discontinuation, 38.6% of patients with eGFR decline did not experience recovery. A higher baseline eGFR, lower discontinuation eGFR and more prolonged TDF exposure were associated with increased risk of incomplete recovery at 6 months post-TDF discontinuation.Conclusions. This study shows that eGFR decline on TDF was not fully reversible in one third of patients, and suggests that prolonged TDF exposure at low eGFR should be avoided.
AB - Background. Tenofovir disoproxil fumarate (TDF) has been linked to renal impairment but the extent to which this impairment is reversible is unclear. We aimed to investigate the reversibility of renal decline on TDF.Methods. Cox Proportional Hazards models assessed factors associated with discontinuing TDF in those with >6 months exposure. In those who discontinued TDF, linear piecewise regression models estimated eGFR slopes (mL/min/1.73 m(2)/yr) before, during and after TDF exposure. Factors associated with not achieving eGFR recovery 6 months after discontinuing TDF were assessed using multivariable logistic regression.Results. We observed eGFR declines during TDF exposure (mean (95% CI) slopes -15.7 (-20.5, -10.9) during the first 3 months; -3.1(-4.6, -1.7) thereafter), and evidence of eGFR increases following discontinuation (12.5 (8.9, 16.1) during the first 3 months; 0.8 (0.1, 1.5) thereafter). Following TDF discontinuation, 38.6% of patients with eGFR decline did not experience recovery. A higher baseline eGFR, lower discontinuation eGFR and more prolonged TDF exposure were associated with increased risk of incomplete recovery at 6 months post-TDF discontinuation.Conclusions. This study shows that eGFR decline on TDF was not fully reversible in one third of patients, and suggests that prolonged TDF exposure at low eGFR should be avoided.
U2 - 10.1093/infdis/jiu107
DO - 10.1093/infdis/jiu107
M3 - Article
C2 - 24585896
SN - 0022-1899
JO - The Journal of Infectious Diseases
JF - The Journal of Infectious Diseases
ER -