Effect of changing from first- to second-line antiretroviral therapy on renal function: a retrospective study based on data from a single health facility in Namibia

Expert Rev Anti Infect Ther. 2016 Aug;14(8):777-83. doi: 10.1080/14787210.2016.1202759. Epub 2016 Jul 14.


Background: Tenofovir disoproxil fumarate (TDF) and lopinavir/ritonavir (LPV/r) can cause renal impairment with this combination co-administered during second-line combination antiretroviral therapy (cART) potentially associated with greater risk of nephrotoxicity. As a result, the aim of this study is to assess effects of second-line cART on renal function.

Methods: Retrospective longitudinal study in patients receiving cART.

Results: 71 patients received TDF, zidovudine or stavudine, each combined with 3TC/NVP or 3TC/EFV. Before second-line cART, 46.5% had abnormal kidney function. First-line cART had no relationship with calculated creatinine clearance (CrCl). During second-line cART, more males than females had abnormal renal function and more females experienced increases in CrCl. Calculated CrCl during second-line cART related strongly with CrCl during first-line cART. Time spent on cART had a weak relationship with CrCl.

Conclusion: Patients on first-line cART for several years without renal impairment may experience new onset impairment during second line cART. Patients with pre-existing renal impairment just before switching to second-line cART may experience a further decline.

Keywords: Namibia; combination antiretroviral therapy; creatinine clearance; drug utilisation study; renal function.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents* / administration & dosage
  • Anti-HIV Agents* / adverse effects
  • Anti-HIV Agents* / therapeutic use
  • Antiretroviral Therapy, Highly Active
  • Creatinine / blood*
  • Female
  • HIV Infections / blood
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • Humans
  • Kidney / drug effects*
  • Kidney Function Tests
  • Male
  • Namibia
  • Retrospective Studies


  • Anti-HIV Agents
  • Creatinine