Incomplete reversibility of eGFR following tenofovir exposure

on behalf of the UK Collaborative HIV Cohort Study Steering Committee, Sophie Jose, Lisa Hamzah, Lucy Campbell, Teresa Hill, Martin Fisher, Clifford Leen, Richard Gilson, John Walsh, Mark Nelson, Phillip Hay, Margaret Johnson, David Chadwick, Dorothea Nitsch, Rachael Jones, Caroline Sabin, Frank Post

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Abstract / Description of output

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.
Original languageEnglish
JournalThe Journal of Infectious Diseases
DOIs
Publication statusPublished - 28 Feb 2014

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