Assessment of renal safety of tenofovir disoproxil fumarate in people living with HIV in Tunisia
Keywords:Tenofovir, HIV, Tunisian patients, Renal safety
Background: Tenofovir disoproxil fumarate (TDF) is a nucleotide reverse transcriptase inhibitor (NRTI). TDF is generally well tolerated. It is eliminated by the combination of glomerular filtration and active renal tubular secretion. Thus, it can be responsible, in the medium and long term, of renal toxicity. The aim of our study is to assess the prevalence of TDF nephrotoxicity and its factors risk in PLHIV treated in the Infectious Diseases Department at the University Hospital of Monastir, Tunisia..
Methods: An observational cross-sectional single-centre prospective study included 62 cases of HIV-infected patients taking antiretroviral therapy (ART) containing TDF was conducted between 1st August 2016 and 31 December 2016 at Fattouma Bourguiba University Hospital of Monastir, in Tunisia. During this period, patients were screened for renal dysfunction to detect renal toxicity, Tubular dysfunction or Fanconi syndrome.
Results: 62 patients were included with female/male ratio at 1,52. The mean age was 39 years Â± 8,5 years. Half of the patients were treated with TDF as first-line therapy. The average duration of TDF was 25 months, the duration was greater than 12 months in 40 (65%) patients. There was a decrease in creatinine clearance in 21 (33.8%) patients, the average of the decrease was 128,6 Â±35,8 ml/min Proximal tubulopathy was noted in 1 patient (1.6%) and no patient had Fanconi syndrome.
No risk factors for renal impairment under TDF were found. This finding could be explained by the small sample size
Conclusion: TDF-related renal toxicity is often asymptomatic, it require early detection. In ours patient cases, TD is rare, but creatinine clearance decrease is frequent and may inform of possible TD in these patient. In order to reduce TDFtoxicity, a new pro-drug, tenofovir alafenamide (TAF), is now available.
- Sterne JA, May M, Costagliola D, Wolf F, Phillips AN, Harris R et al. Timing of initiation of antiretroviral therapy in AIDS- free-HIV-1- infected patients: A collaborative analysis of 18 HIV cohort study. When to start consortium. Lancet 2009 ; 373 : 1352-63.
- World health Organisation. The use of antiretroviral drugs for treating and preventing HIV infection. June 2016.
- Highleyman L. Risk factors for kidney toxicity, in patients taking Tenofovir. Glasgow: UK-CAB 2007; 16: 12-6.
- M. Ondounda, A. Tanon, E. Ehui, I. Ouattara, A. Kassi, Y.T. Aba, E.F. Aoussi, A.R. Kakou, S.P. EholiÃ©, E. Bissagnene, A. Kadio . Le syndrome de Fanconi induit par le tÃ©nofovir en Afrique : deux cas en CÃ´te dâ€™Ivoire â€. Med Mal Infect 2011 ;41:105.
- Nelson MR, Katlama C, Montaner JS, Cooper DA, Gazzard B, Clotet B. The safety of tenofovir disoproxil fumarate for the treatment of HIV infection in adults: the first 4 years. AIDS 2007 ; 21 : 1273â€“81.
- Isnard-Bagnis C, Aloy B, Deray G, Tourret J. Tenofovir nephrotoxicity. Nephrol et Therap 2016 ; 12 : 179â€“89.
- Winston A, Amin J, Mallon P, Marriott D, Carr A, Cooper DA. Minor changes in calculated creatinine clearance and anion-gap are associated with tenofovir disoproxil fumarate-containing highly active antiretroviral therapy. HIV Med 2006 ; 7 : 105â€“11.
- Herlitz LC, Mohan S, Stokes MB, Radhakrishnan J, Dâ€™Agati VD, Markowitz GS. Tenofovir nephrotoxicity: acute tubular necrosis with distinctive clinical, pathological, and mitochondrial abnormalities. Kidney Int 2010 ; 78 : 1171-7.
- David R. Chadwick, Fred S. Sarfo, Elaine S. M. Kirk, Dorcas Owusu, George Bedu-Addo, Victoria Parris and al. Tenofovir is associated with increased tubular proteinuria and asymptomatic renal tubular dysfunction in Ghana. BMC Nephrol 2015; 16 : 195.
- Ryom L, Mocroft A, Kirk O, Worm SW, Kamara DA, Reiss P, et al. Association between antiretroviral exposure and renal impairment among HIV-positive persons with normal baseline renal function: the D:A:D study. J Infect Dis 2013 ; 207 : 1359â€“69.
- Madeddu G, Bonfanti P, De Socio GV, Carradori S, Grosso C, Marconi P. Tenofovir renal safety in HIV-infected patients: results from the SCOLTA Project. Biomed Pharmac- other 2008; 62 : 6â€“11.
- Nishijima T, Komatsu H, Gatanaga H, Aoki T, Watanabe K, Kinai E. Impact of small body weight on tenofovir-associated renal dysfunction in HIV-infected patients: a retrospective cohort study of Japanese patients. PLoS One 2011 ; 6 : 22661.
- Gupta SK, Eustace JA, Winston JA, Boydstun II, Ahuja TS, Rodriguez RA. Guidelines for the management of chronic kidney disease in HIV-infected patients: recommendations of the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis 2005 ; 40 : 1559â€“85.
- L. Cotte, C. Katlama, F. Post, A. Clarke, W. Short, M. Das, M. Fordyce, TolÃ©rance Ã plus long terme du tÃ©nofovir alafÃ©namide chez lâ€™insuffisant rÃ©nal. Med Mal Infect 2016 ; 46 : 117-27.
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access and Benefits of Publishing Open Access).
This journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge.
Articles are published Under License of Creative Commons Attribution 3.0 License Â©
Copyright policies & self-archiving
|Author's Pre-print:||author can archive pre-print (ie pre-refereeing)|
|Author's Post-print:||author can archive post-print (ie final draft post-refereeing)|
|Publisher's Version/PDF:||author can archive publisher's version/PDF|