Discontinuation and Dose Adjustment of Tenofovir in HIV Patients with Impaired Renal Function Pages 55-62

Andreas Dissing1, Rebecca Legarth2, Marie Helleberg2, Gitte Kronborg3, Jan Gerstoft2, Niels Obel2 and Court Pedersen1

1Department of Infections Diseases, Odense University Hospital, Odense, Denmark; 2Department of Infections Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark; 3Department of Infections Diseases, Copenhagen University Hospital, Hvidovre, Denmark

DOI: http://dx.doi.org/10.12970/2309-0529.2013.01.02.4

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Abstract: Background: Impaired renal function is a major concern in HIV-infected patients treated with tenofovir. We undertook this study to clarify how reduced renal function in patients on tenofovir treatment is handled in routine clinical practice.

Methods: From a population-based cohort of Danish HIV patients we identified all patients who started tenofovir for the first time and estimated relative risk (RR) of discontinuation of tenofovir in relation to baseline and last estimated glomerular filtration rate (eGFR, measured in ml/min per 1.73 m2). For patients who for the first time had eGFR<50, we calculated time to the combined endpoint of eGFR>50 or stop or dose modification.

Results: 2,066 patients were included in the study. Patients with last eGFR<65 had increased risk of stopping tenofovir and the risk increased with decreasing eGFR (eGFR 60-65: adjusted RR 2.1; eGFR <50: adjusted RR 8.1). We identified 115 patients with eGFR<50. After 1 year only 12.3% were still on standard dose tenofovir and had eGFR<50.

Conclusion: This study demonstrates that tenofovir treatment is stopped rapidly in patients who develop renal impairment. Patients with a normal baseline renal function have a low risk of treatment modification.

Keywords: HIV, tenofovir, renal function, clinical handling. Read more