Are comorbidities and previous antiretroviral therapy associated with renal dysfunction in patients with HIV infection treated with tenofovir-based regimen?

Abstract

Background: TLD, Tenofovir disoproxil fumarate (TDF)/ lamivudine (3TC)/ dolutegravir (DTG), is one of the antiretroviral therapy (ART) for patients with HIV infection and can be used as the first-line treatment. The main concern of TLD is renal dysfunction. However, there is limited data if any comorbidities or previous ART was associated with renal dysfunction in patients with HIV infection treated with TLD. Objective: To evaluate if any comorbidities or previous ART associated with renal dysfunction in this setting. Methods: This study was a retrospective cohort study. The inclusion criteria were adult patients diagnosed as HIV infection, received treatment with TLD for at least 12 months, and had regular follow-up. The primary outcome was a decline of eGFR of 25% or more after treatment with TLD for 12 months. Factors associated with the primary outcome were computed by using logistic regression analysis. Results: There were 1,340 patients met the study criteria. Of those, 461 patients (34.40%) had eGFR decline of 25% or more after TLD treatment for 12 months. Four factors were significantly related with eGFR decline of 25% or more: naïve patient with TDF, and previous treatment with TDFFTCEFV (TEEVIR), AZT3TCNVP (GPOZ), and AZT3TCEFV. Previous treatment with AZT3TCEFV had the highest adjusted odds ratio of 2.992 (95% confidence interval of 1.682, 5.322), while TDFFTCEFV (TEEVIR) and AZT3TCNVP (GPOZ) had the adjusted odds ratio of 1.898 and 1.967, respectively. Conclusions: The prevalence of eGFR decline of 25% or more after TLD treatment for 12 months was 34.40%. Risk factors for eGFR decline of 25% or more included naïve patients to TLD or previously treated with tenofovir-based or zidovudine-based regimens.