2183. Outcomes of tenofovir discontinuation among human immunodeficiency virus (HIV)-infected patients with suspected tenofovir-associated nephrotoxicity
Session: Poster Abstract Session: HIV Renal and Bones
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • TDF Study - IDWeek 2016 Poster.pdf (186.8 kB)
  • Background: Tenofovir-associated nephrotoxicity (TAN) has been approximated at a yearly incidence of 1%. Limited data exist regarding the reversibility of TAN. The aim of this study is to describe outcomes of tenofovir discontinuation (d/c) among HIV-infected patients with suspected TAN.

    Methods: This retrospective, single-center, observational, cohort study enrolled HIV-infected patients who discontinued tenofovir disoproxil fumarate (TDF) due to suspected TAN from 2005 to 2015. Patients must have had serum creatinine ≥ 1.3 mg/dL to be included. Patients with pre-existing renal dysfunction were excluded. Renal function was estimated pre-TDF, at time of suspected TAN, and at pre-specified time periods up to 5 years after TDF d/c. Estimated glomerular filtration rate (eGFR) was calculated using Modification of Diet in Renal Disease (MDRD) equation. Improvement was defined as eGFR increase ≥7 mL/min/m2. Recovery was defined as return to pre-TDF renal function. Time-to-event analysis was performed to assess speed of improvement and recovery. Logistic regression was performed to assess factors associated with recovery.

    Results: Sixty patients met study criteria. Median eGFR pre-TDF, at TDF d/c, and after TDF d/c were 78.3, 51.7, and 73.5 mL/min/m2, respectively (eGFR at TDF d/c vs after TDF d/c; p<0.001). The majority of patients (80%) had improvement, but only half of these (40%) had recovery. Time-to-event analysis revealed a median time to improvement and recovery of 5 and 52 months, respectively. No factors were found to be associated with recovery in the multivariate logistic regression.

    Variable

    Univariate Analysis

    OR (95% CI);p-value

    Male

    8.8 (1.5, 168.7);0.045

    Pre-treatment HIV RNA (log)

    0.5 (0.21, 1.1);0.095

    Pre-treatment CD4 (per every 50 cells/mm3)

    1.1 (0.97, 1.2);0.16

    Pre-treatment CD4 <200 cells/mm3

    0.4 (0.1, 1.1);0.091

    Receipt of thiazide at time of recovery

    3 (0.98, 9.42);0.058

    Number of prior antiretroviral regimens

    1.5 (1.04, 2.1);0.033

    Number of prior antiretrovirals

    1.2 (1.03, 1.5);0.029

    Conclusion: Among patients with suspected TAN, renal function improves for most patients after TDF d/c, but not all patients fully recover. A patient’s greatest improvement may not occur until many months after TDF d/c.

    Disclosures: All authors: No reported disclosures.

    Dustin Carr, PharmD1, James Johnson, PharmD1, Aimee Wilkin, MD, MPH2, Haley Gibbs, PharmD, MPH1 and John Williamson, PharmD1, (1)Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, (2)Department of Internal Medicine, Section on Infectious Diseases, Wake Forest Baptist Health, Winston-Salem, NC

    Disclosures:

    D. Carr, None

    J. Johnson, None

    A. Wilkin, None

    H. Gibbs, None

    J. Williamson, None

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