587. Incidence of Nephrotoxicity Among Antiretroviral Therapy-naïve Patients with Human Immunodeficiency Virus Infection Taking Tenofovir at the Philippine General Hospital
Session: Poster Abstract Session: HIV: Kidney, Bone + Liver Effects
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • 587_IDWPoster.pdf (928.5 kB)
  • Background:

    Tenofovir (TDF) is a first-line antiretroviral (ARV) drug for HIV. The dramatic rise of HIV in the Philippines has resulted in increased TDF use. We aimed to determine the incidence and risk factors of nephrotoxicity among Filipino HIV patients on TDF.

     Methods:

    We reviewed medical records of adult patients on TDF in the Philippine General Hospital HIV clinic from 1/2004 to 12/2016. Nephrotoxicity was defined as ≥20% decline in estimated glomerular filtration rate (eGFR). Relevant demographic data including infection history, baseline serum creatinine and urinalysis were collected. Statistical analysis was performed to compare characteristics between groups. Kaplan Meier method was used to determine incidence rate over time, and incidence density rates of nephrotoxicity were also calculated.

    Results:

    A total of 670 patients were included with mean age of 30.70 years (30.70±7.97) and male-female ratio of 73:1. Nephrotoxicity incidence was 50.60% with a density rate of 1.1048 per 1,000 person days. Associated risk factors are shown in Table 1. Kaplan Meier analysis showed probability of nephrotoxicity of 50% at 615 days (Figure 1).

    Table 1. Patient Characteristics and Risk Factors Associated with Nephrotoxicity
      > 20% eGFR decline (n=335) < 20% eGFR decline (n=326) P-Value
    Frequency (%); Mean ± SD; Median (Range)
    Age 31.79 ± 8.84 29.65 ± 6.82 0.001§
    Body Mass Index (BMI) (n=504) 20.91 ± 3.77 21.59 ± 3.54 0.039§
    Medical History      
         Tuberculosis 144 (42.99) 125 (38.34) 0.225*
         P. jiroveci pneumonia 69 (20.60) 47 (14.42) 0.037*
         CNS Toxoplasmosis 2 (0.6) 5 (1.53) 0.280Ɨ
         TMP SMX use 174 (51.94) 151 (46.32) 0.148*
    Baseline CD4 count (cells/m3) 124.5 (1 to 966) 185 (2 to 1,044) 0.045ǂ
    Mean baseline serum creatinine (mg/dl) 0.81 ± 0.17 0.96 ± 0.22 <0.0001§
    Mean baseline eGFR 124 ± 32.33 103.52 ± 24.15 <0.0001§

    * – Chi-square test; Ɨ – Fisher’s Exact test; ǂ – Mann-Whitney U test; § – Independent Sample T-test

    Figure 1. Time to nephrotoxicity from TDF initiation.

    Conclusion:

    Tenofovir can cause significant nephrotoxicity over time even among young HIV patients. Fifty percent of patients taking TDF developed nephrotoxicity by 18 months. Associated risk factors include older age, lower BMI, P. jiroveci pneumonia, lower baseline CD4 count, serum creatinine and eGFR. Clinicians must be aware of the increased risk of nephrotoxicity with prolonged use.

     

    Marja Bernardo-Buensalido, MD, Section of Infectious Diseases, Philippine General Hospital, Manila, Philippines and Cybele Lara Abad, MD, FIDSA, Section of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines

    Disclosures:

    M. Bernardo-Buensalido, None

    C. L. Abad, None

    Previous Abstract | Next Abstract >>

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.