Factors predicting renal impairment associated with Tenofovir Disoproxil fumarate: Focus on patients with HIV and pre-existing metabolic abnormalities under the Thai National Health Security Scheme

Objective

The incidence of nephrotoxicity is reported as 20 % among Thai patients with HIV receiving tenofovir disoproxil fumarate (TDF). It can occur as early as 24 weeks after initiating TDF therapy. Metabolic abnormalities are the major comorbidities in patients with HIV receiving antiretrovirals. However, close monitoring for renal function and metabolic abnormalities is not possible under Thai National Health Security Scheme for either HIV or AIDS patients due to the significant budget constraints. This study aims to investigate the predictive factors of TDF associated with renal impairment in patients with HIV and pre-existing metabolic abnormalities.

Methods

This longitudinal study was conducted at a university hospital in Bangkok, Thailand from January 2015 to December 2018. All participants were followed until the first occurrence of an estimated glomerular filtration rate (eGFR) ≤ 90 mL/min/1.73 m².

Results

Among 315 patients with pre-existing metabolic abnormalities, elevated low-density lipoprotein was the most common (47.3 %) while TDF/emtricitabine/efavirenz was the most common (75.2 %) regimen of highly active antiretroviral therapy. In addition, the body mass index (BMI) < 18.5 kg/m² (odds ratio [OR] = 9.20, 95 % confidence interval [CI]: 1.11, 76.50) and baseline eGFR (OR = 0.92, 95 % CI: 0.89, 0.94) were predictive factors of renal impairment.

Conclusions

For patients with HIV and pre-existing metabolic abnormalities in resource limited settings, maintaining a normal BMI and adjusting antiretroviral treatment dose according to renal function are recommended, especially in those with abnormal baseline eGFR.