RESEARCH ARTICLE


Incidence Rate and Time to Occurrence of Renal Impairment and Chronic Kidney Disease among Thai HIV-infected Adults with Tenofovir Disoproxil Fumarate Use



Jirayu Visuthranukul1, 2, Thanapoom Rattananupong1, Phenphop Phansuea3, Narin Hiransuthikul1, *
1 Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
2 Infectious Disease Unit, Department of Internal Medicine, Police General Hospital, Bangkok, Thailand
3 Institute of Nutrition, Mahidol University, Nakhon Pathom, Thailand


© 2021 Visuthranukul et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Tel: (662) 2527864; Fax: (662) 2564292; E-mail: nhiransu@gmail.com


Abstract

Background:

Tenofovir disoproxil fumarate (TDF) is a major antiretroviral therapy for Thai human immunodeficiency virus (HIV) infected adults. TDF is associated with a decrease in renal function. There is limited data about the use of TDF with the incidence and time to renal impairment and chronic kidney disease (CKD) in Thai HIV-infected adults.

Objectives:

To study the association of TDF with the incidence rate and duration of renal impairment and CKD in Thai patients.

Methods:

A retrospective cohort study in Thai naïve HIV-infected adults was conducted to compare the incidence rate and time to renal impairment and CKD in TDF and non-TDF groups. The incidence rate was analyzed by person-time. Time to renal impairment and CKD were analyzed by Kaplan-Meier curves and log-rank tests.

Results:

A total of 1,400 patients were enrolled. The incidence rates of renal impairment in TDF and non-TDF groups were 27.66/1,000 and 5.54/1,000 person-years. The rate ratio was 4.99 (95% confidence interval [CI] 2.66–9.35). The incidence rates of CKD in both groups were not significantly different. Themean difference of eGFR between the TDF and non-TDF groups was 1.92 ml/min/1.73 m2 (p = 0.022). Time to onset of renal impairment between the TDF and non-TDF groups was found to differ by approximately 20 months.

Conclusion:

The incidence rate of renal impairment was about five times higher in the TDF group. A rapid decline of eGFR occurred in the first 2–3 years of treatment. Therefore, the renal function of HIV-infected patients should be monitored so that the severity of renal impairment could be evaluated and CKD could be prevented.

Keywords: HIV infection, Tenofovir disoproxil fumarate, Antiretroviral therapy, Renal impairment, Chronic kidney disease, Liver disease.