Renal outcomes after up to eight years of tenofovir exposure in HIV–HBV-coinfected patientsReportar como inadecuado

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* Corresponding author 1 iPLESP - Institut Pierre Louis d-Epidémiologie et de Santé Publique 2 CRCL - Centre de Recherche en Cancérologie de Lyon 3 Service des maladies infectieuses et tropicales Lyon 4 Service des Maladies Infectieuses et Tropicales CHU Saint Louis 5 Services des Maladies Infectieuses et Tropicales CHU Saint-Antoine 6 Des Maladies Rénales Rares aux Maladies Fréquentes, Remodelage et Réparation 7 Service de Néphrologie et Dialyses CHU Tenon

Abstract : Background: Renal toxicity is a common side effect during tenofovir TDF-use in HIV-infected, but not necessarily HBV-infected, patients. Nevertheless, little is known regarding TDF-use on renal impairment during HIV–HBV coinfection. We aimed to evaluate the progression and determinants of renal impairment in coinfected patients undergoing TDF.Methods: A total of 175 coinfected patients initiating TDF-containing antiretroviral therapy were prospectively followed. Estimated glomerular filtration rates eGFR were calculated at baseline and every 6–12 months. Determinants of eGRF change from baseline ΔeGFR were evaluated using mixed-effect linear regression and progression towards renal impairment using proportional-hazards regression.Results: At baseline, average eGFR was 96.7 ml-min per 1.73m2 95% CI 93.8, 99.6. During a median 58.3 months IQR 33.7–92.1 of treatment, eGFR decreased a monthly average of -0.14 ml-min per 1.73m2 95% CI -0.16 -0.12. Significantly faster ΔeGFR was associated with baseline eGFR>90 P=0.002, male gender P=0.04, previous AIDS-defining illness at baseline P=0.03, baseline liver cirrhosis P=0.03 and concomitant protease inhibitor use P=0.005. Between respective baseline and end of follow-up visits, the proportion of patients with renal impairment increased: normal function, 65.7% to 53.1%; mild impairment, 32.6% to 40.0%; moderate impairment, 1.7% to 6.9%. Higher age P=0.01 and previous AIDS-defining illness P=0.02 at baseline were independent risk-factors for developing impairment, while undetectable HBV DNA on-treatment was protective P=0.006. Five 2.9% patients permanently discontinued TDF after a renal event.Conclusions: Severe HIV-related and HBV-related morbidity negatively affects renal function in coinfected patients undergoing long-term TDF. Although most patients only developed mild-moderate impairment, close renal monitoring is warranted for this particular population.

Autor: Anders Boyd - Patrick Miailhes - Caroline Lascoux-Combe - Hayette Rougier - Pierre-Marie Girard - Emmanuelle Plaisier - Karine La



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