Incomplete reversibility of tenofovir-related renal toxicity in HIV-infected men

J Acquir Immune Defic Syndr. 2010 Sep;55(1):78-81. doi: 10.1097/QAI.0b013e3181d05579.

Abstract

Background: Significant nephrotoxicity develops in 1%-2% of HIV-infected adults receiving tenofovir (TDF). This nephrotoxicity is said to resolve rapidly, but this assessment is based on short follow-up, very few patients and use of serum creatinine, an insensitive measure of renal function.

Methods: We determined the reversibility of TDF-related nephrotoxicity in 24 HIV-infected male outpatients who ceased TDF for renal impairment by retrospective assessment of estimated glomerular filtration rate (eGFR) using the Modified Diet in Renal Disease equation.

Results: Median (interquartile range) eGFR pre-TDF was 74 (61-88) mL.min.1.73 m, fell to 51 (39-61) mL.min.1.73 m at TDF cessation and increased to 58 (48-70) mL.min.1.73 m a median 13 months after TDF cessation (most recent vs pre-TDF eGFR; P = 0.0008). Results were similar with the Cockcroft-Gault equation and after exclusion of patients who had shorter follow-up after TDF cessation. Only 10 (42%) patients reached their pre-TDF eGFR. Greater eGFR improvement was significantly associated with more rapid decline in eGFR on TDF therapy and in those who received TDF with a protease inhibitor, with a trend for shorter duration of TDF therapy.

Discussion: In this population, TDF-related renal toxicity was not always fully reversible.

MeSH terms

  • Adenine / adverse effects
  • Adenine / analogs & derivatives*
  • Adenine / therapeutic use
  • Anti-HIV Agents / adverse effects*
  • Anti-HIV Agents / therapeutic use
  • Glomerular Filtration Rate / drug effects
  • HIV Infections / drug therapy*
  • Humans
  • Kidney / drug effects*
  • Kidney / pathology
  • Kidney Diseases / chemically induced*
  • Male
  • Middle Aged
  • Organophosphonates / adverse effects*
  • Organophosphonates / therapeutic use
  • Tenofovir
  • Withholding Treatment

Substances

  • Anti-HIV Agents
  • Organophosphonates
  • Tenofovir
  • Adenine