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Incomplete reversibility of eGFR following tenofovir exposure.

Jose, S; Hamzah, L; Campbell, L; Hill, T; Fisher, M; Leen, C; Gilson, R; ... on behalf of the UK Collaborative HIV Cohort Study Steering Comm, ; + view all (2014) Incomplete reversibility of eGFR following tenofovir exposure. J Infect Dis , 210 (3) pp. 363-373. 10.1093/infdis/jiu107. Green open access

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Abstract

Background. Tenofovir disoproxil fumarate (TDF) has been linked to renal impairment but the extent to which this impairment is reversible is unclear. We aimed to investigate the reversibility of renal decline on TDF.Methods. Cox Proportional Hazards models assessed factors associated with discontinuing TDF in those with >6 months exposure. In those who discontinued TDF, linear piecewise regression models estimated eGFR slopes (mL/min/1.73 m(2)/yr) before, during and after TDF exposure. Factors associated with not achieving eGFR recovery 6 months after discontinuing TDF were assessed using multivariable logistic regression.Results. We observed eGFR declines during TDF exposure (mean (95% CI) slopes -15.7 (-20.5, -10.9) during the first 3 months; -3.1(-4.6, -1.7) thereafter), and evidence of eGFR increases following discontinuation (12.5 (8.9, 16.1) during the first 3 months; 0.8 (0.1, 1.5) thereafter). Following TDF discontinuation, 38.6% of patients with eGFR decline did not experience recovery. A higher baseline eGFR, lower discontinuation eGFR and more prolonged TDF exposure were associated with increased risk of incomplete recovery at 6 months post-TDF discontinuation.Conclusions. This study shows that eGFR decline on TDF was not fully reversible in one third of patients, and suggests that prolonged TDF exposure at low eGFR should be avoided.

Type: Article
Title: Incomplete reversibility of eGFR following tenofovir exposure.
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/infdis/jiu107
Publisher version: http://dx.doi.org/10.1093/infdis/jiu107
Additional information: © The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases SocietyofAmerica. This is anOpen Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: tenofovir; highly active antiretroviral therapy; eGFR; eGFR slopes; renal function; kidney;
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/1422649
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