[19] Tenofovir-associated renal insufficiency in HIV infected women

8th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV

San Francisco, California - September 24 - 26, 2006

TENOFOVIR-ASSOCIATED RENAL INSUFFICIENCY IN HIV INFECTED WOMEN

Antiviral Therapy 2006; 11:L13 (abstract no. 19)

DW Lin¹, M Gandhi¹, P Bacchetti¹, N Ameli¹, A Pao¹, S Buchbinder², R Rodriguez¹, R Greenblatt¹ and KM Giacomini¹
¹University of California San Francisco, San Francisco, CA, USA; ²San Francisco Department of Public Health, San Francisco, CA, USA

BACKGROUND: Tenofovir is a widely prescribed nucleotide reverse transcriptase inhibitor used for treatment of human immunodeficiency virus (HIV). Controversy surrounds the prevalence of tenofovir-associated renal impairment. We conducted a study using the Women’s Interagency HIV Study (WIHS) cohort to assess the association, magnitude and risk factors of tenofovir-associated renal impairment in women with HIV.

METHODS: Data from 645 previously tenofovir-naïve women in WIHS on tenofovir from ranging from 3 to 24 months were used. Estimated glomerular filtration rates (eGFR) were calculated using the Modification of Diet in Renal Disease equation (MDRD). eGFR prior to tenofovir use (baseline eGFR) was calculated by averaging the last two eGFRs prior to tenofovir treatment to minimize regression to the mean. eGFR during tenofovir treatment was obtained from the first visit after initial tenofovir administration. Repeated measures random effects multivariate linear regression modelling and linear spline modelling were used to assess the association of tenofovir with renal insufficiency. Our model adjusted for race, viral load, CD4 count, age, baseline renal status, form of antiretroviral therapy and hypertension.

RESULTS: See Tables 1 and 2.

CONCLUSIONS: Our repeated measures random effects multivariate regression analysis demonstrated that tenofovir was associated with a statistically significant decline (7.86 ml/min) in eGFR (Table 1). eGFR declined over time during tenofovir therapy (Table 2). On average, the decline was sustained above 80 ml/min up to 42 months. This analysis suggests that among HIV-infected women, tenofovir is an important risk factor for renal insufficiency.


Table 1. (Abstract 19). Adjusted eGFR declined in 645 women on tenofovir therapy using repeated measures random effects multivariate linear regression

Variable	Coefficient	P-value	95% CI

Tenofovir	-7.86	0.00	-11.73; -3.91


Table 2. (Abstract 19). eGFR declined with time following tenofovir therapy

Months, n	eGFR	P-value	95% CI

0	98.0	0.00	92.3; 103.8
6	94.1	0.00	89.0; 101.2
12	88.5	0.00	82.4; 94.5
18	84.3	0.00	78.0; 90.6
24	83.4	0.00	76.7; 90.1
30	82.3	0.00	75.1; 89.5
36	85.5	0.00	78.6; 92.4
42	84.3	0.00	77.7; 90.9

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2006-09-24
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