Prognosis of Renal Function, Risk of Dialysis and Mortality in HIV Patients Developing Moderate Impaired Renal Function During Treatment with Tenofovir or Abacavir

Abstract

 Background: Impaired renal function is a concern in HIV-infected patients treated with tenofovir. We undertook this study to investigate the prognosis ofrenal function risk of dialysis and mortality in HIV patients developing moderately reduced renal function while on tenofovir or abacavir. Methods: From a population based cohort of Danish HIV patients, we identified all patients who for the first time had an estimated glomerular filtration rate (eGFR)<50 ml/min per 1.73 m2 while on tenofovir or abacavir. We calculated median eGFR and the fraction of patients with eGFR<60 ml/min per 1.73 m2 during followup in the two groups. Cox regression was used to estimate unadjusted and adjusted mortality rate ratios (MRR). Results: We identified 61 patients on tenofovir and 55 on abacavir who developed impaired renal function. Throughout the 2-year study period, the tenofovir group contributed with 87.6 years and the abacavir group with 79.4 years of follow-up. We found no difference between the groups regarding median eGFR or proportions of patients having eGFR <60 ml/min per 1.73 m2 over time. Five patients in the tenofovir group and two in the abacavir group initiated dialyses within two years after study inclusion. Our study did not indicate that the tenofovir group had increased risk of death (adjusted MRR=0.66, 95% CI: 0.37-1.17). Conclusions: Within the current clinical setting, we were not able to detect a statistical significant difference in renal outcome and mortality between patients developing reduced renal function while on tenofovir or abacavir.