Methods: We conducted a retrospective review of HIV infected patients treated with TDF in a Ryan White funded clinic at the University of Kentucky which provides HIV care to ~ 1600 patients from central and eastern Kentucky. To be included, subjects had to be at least 18 years of age and started a TDF containing regimen between January 1, 2012 and December 31, 2016. Follow-up was through March 2017. We collected demographic and relevant clinical data from the Electronic Medical Record. Acute kidney injury (AKI) was defined as a ≥ 50% rise in serum creatinine after TDF initiation. Primary outcome was time to AKI using Kaplan-Meier (KM) and Cox Proportional Hazards analyses.
Results: The 660 subjects meeting inclusion criteria were largely male (79.8%) and ethnically white (69.7%), African-American (22.6%), and Hispanic (6.8%). Average age was 41.2 yrs (SD
11.9 yrs). During the study period 88 subjects developed AKI. In KM analyses, risk of AKI was greater for females (p=0.041), upper tertile of age (> 47.5 yrs, p=0.024), and among patients with hypertension (p=0.001), diabetes mellitus (DM) (p=0.02) having detectable HIV viremia (p=0.0004) or Hepatitis C viremia (p=0.00002). In the Cox model, female sex (hazard ratio [HR]=1.68, p=0.035), upper tertile of age (HR=1.94, p=0.026), HTN (HR=1.70, p=0.023), unsuppressed HIV viral load (HR=2.75, p=0.00008), and Hepatitis C viremia (HR=2.65, p=0.0002) increased risk of AKI. Neither ethnicity nor DM were associated with AKI.
Conclusion: The factors associated with greatest AKI risk during TDF treatment were hepatitis C viremia and HIV viremia. Older age, female sex, and hypertension were significantly associated with increased AKI . We found neither DM nor ethnicity were independently associated with AKI.
A. Thornton, None
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