402. Renal Function in HIV-Infected Veterans on Tenofovir with and without Ritonavir Compared with Those on No Tenofovir and No Antiretroviral Therapy
Session: Poster Abstract Session: HIV - Antiretroviral Therapy
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • TDF_poster_IDSA 2011.pdf (507.0 kB)
  • Background: Tenofovir (TDF) is renally cleared by glomerular filtration and active tubular secretion. Previous studies have shown conflicting data regarding the safety of TDF in combination with a ritonavir-boosted protease inhibitor (PI/r) at times indicating that this combination raised plasma TDF levels by 20-30%.

    Methods: Patients on TDF+PI/r or TDF+non-nucleoside reverse transcriptase inhibitor (NNRTI) for >12 months at our VA Medical Center were retrospectively compared with those who received no (naïve) or other antiretroviral agents (other ARV) for differences in estimates of glomerular filtration rate at 0, 6 and 12 months using Modification of Diet and Renal Disease (MDRD) in ml/min/1.73m2 and tested by analysis of variance using SAS version 9.2 (Cary, NC).

    Results: Of the 1021 patients reviewed, 650 met our criteria for inclusion into the 4 patient groups listed below. There were no significant differences in mean age, African-American race, male gender, renal failure, hypertension, diabetes, and drugs contributing to renal insufficiency.

    PARAMETER

    Time Point

    (months)

    Naïve

    (n=131)

    Other ARV

    (n=151)

    TDF + PI/r (n=186)

    TDF + NNRTI (n=182)

     

     

     

     

     

     

    Mean CD4**             

    0

    640 ± 283

    322 ± 230

    240 ± 193

    397 ± 304

     

    6

    630 ± 299

    399 ± 222

    304 ± 202

    482 ± 294

     

    12

    604 ± 279

    438 ± 226

    316 ± 204

    504 ± 306

    Undetectable VL*    

    0

    23/129

    3/151

    30/184

    64/182

     

    6

    21/131

    102/151

    90/176

    135/178

                               

    12

    15/130

    104/150

    92/171

    141/177

    Creatinine             

    0

    1.2 ± 1.2

    1.4 ± 1.7

    1.3 ± 1.5

    1.1 ± 1.0

                                 

    6

    1.2 ± 1.1

    1.4 ± 1.7

    1.4 ± 2.0

    1.1 ± 0.9

                               

    12

    1.3 ± 1.4

    1.4 ± 1.4

    1.4 ± 1.9

    1.1 ± 0.9

    MDRD                  

    0

    103 ± 29

    101 ± 34

    99 ± 31

    100 ± 24

     

    6

    103 ± 28

    99 ± 34

    94 ± 30

    97 ± 22

     

    12

    103 ± 28

    98 ± 33

    94 ± 32

    96 ± 23

    *p<0.05 by one-way ANOVA on 4 treatment groups; **p<0.05 by repeated measures ANOVA on 3 time points.

    Conclusion: TDF+PI/r compared with TDF+NNRTI, other ARV therapy and treatment naiveté was not associated with significant declines in renal function within 12 months. Although our patients were older, primarily African-American men with high prevalence of hypertension and diabetes, our data demonstrate the relative safety of TDF+PI/r.


    Subject Category: H. HIV/AIDS and other retroviruses

    Seema U. Nayak, MD1,2, Maggie Czarnogorski, MD1, Richard Amdur, MD3 and Virginia L. Kan, MD1,2, (1)Medical Service, Infectious Diseases Section, Veterans Affairs Medical Center District of Columbia, Washington, DC, (2)George Washington University, Washington, DC, (3)Veterans Affairs Medical Center District of Columbia, Washington, DC

    Disclosures:

    S. U. Nayak, None

    M. Czarnogorski, None

    R. Amdur, None

    V. L. Kan, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.