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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e3181be6be2
Clinical Science

Impact of Tenofovir on Renal Function in HIV-Infected, Antiretroviral-Naive Patients

Horberg, Michael MD*†; Tang, Beth MA‡; Towner, William MD§; Silverberg, Michael PhD*†; Bersoff-Matcha, Susan MD¶; Hurley, Leo MPH*†; Chang, Joseph PharmD§; Blank, Jackie MBA¶; Quesenberry, Charles Jr PhD†; Klein, Daniel MD‖

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Objective: To better characterize the long-term effects of tenofovir on renal function in a large managed care organization.

Methods: We performed a retrospective cohort analysis in Kaiser Permanente for years 2002 to 2005 comparing renal function among antiretroviral naïve patients initiating a tenofovir-containing regimen (964 patients) or tenofovir-sparing regimens (683 patients). We evaluated glomerular filtration rate (GFR, [Modification of Diet in Renal Disease equation]), serum creatinine, and the development of renal proximal tubular dysfunction. We report multivariable hazard ratios (HR, Cox modeling) and linear outcomes (repeated measures) with predictors retained if P < 0.10 (backward selection). Potential predictor variables included in multivariate models were age, sex, Black race, baseline laboratories (including CD4 count), history of diabetes mellitus, hypertension, malignancy, hepatitis, and concurrent medications.

Results: Overall, tenofovir-exposed patients had a larger relative decline in GFR through 104 weeks (−7.6 mL/min/1.73 m2 relative to tenofovir-sparing, P < 0.001); the degree of the difference varied by baseline GFR, with the greatest effect seen in those patients with GFR greater than 80 mL/min/1.73 m2. Tenofovir-exposed patients had greater development of proximal tubular dysfunction over time (at 52 wk: HRadjusted = 1.95 [P = 0.01] and at 104 wk: HRadjusted = 5.23 [P = 0.0004]) and had greater risk of medication discontinuation (HRadjusted = 1.21, P = 0.02), especially as renal function worsened. Viral control and CD4 count changes were similar between the two groups.

Conclusions: Tenofovir is associated with greater effect on decline in renal function and a higher risk of proximal tubular dysfunction in antiretroviral naïve patients initiating antiretroviral therapy.

© 2010 Lippincott Williams & Wilkins, Inc.


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