Villa, G, Phillips, R O, Smith, C, Stockdale, A J, Beloukas, A, Appiah, L T, Chadwick, D, Ruggiero, A, Sarfo, F S, Post, F and Geretti, A M (2018) Renal health after long-term exposure to tenofovir disoproxil fumarate (TDF) in HIV/HBV positive adults in Ghana. Journal of Infection, 76 (6). pp. 515-521. ISSN 0163-4453

PDF - Published Version Available under License Creative Commons Attribution. Download (477kB)

Abstract

Objectives: The study assessed markers of renal health in HIV/HBV co-infected patients receiving TDF- containing antiretroviral therapy in Ghana.
Methods: Urinary protein-to-creatinine ratio (uPCR) and albumin-to-protein ratio (uAPR) were measured cross-sectionally after a median of four years of TDF. At this time, alongside extensive laboratory testing, patients underwent evaluation of liver stiffness and blood pressure. The estimated glomerular filtration rate (eGFR) was measured longitudinally before and during TDF therapy.
Results: Among 101 participants (66% women, median age 44 years, median CD4 count 572 cells/mm 3 ) 21% and 17% had detectable HIV-1 RNA and HBV DNA, respectively. Overall 35% showed hypertension, 6% diabetes, 7% liver stiffness indicative of cirrhosis, and 18% urinary excretion of Schistosoma antigen. Tubular proteinuria occurred in 16% of patients and was independently predicted by female gender and hypertension. The eGFR declined by median 1.8 ml/min/year during TDF exposure (IQR −4.4, −0.0); more pronounced declines ( ≥5 ml/min/year) occurred in 22% of patients and were associated with receiv-ing ritonavir-boosted lopinavir rather than efavirenz. HBV DNA, HBeAg, transaminases, and liver stiffness were not predictive of renal function abnormalities.
Conclusions: The findings mandate improved diagnosis and management of hypertension and suggest targeted laboratory monitoring of patients receiving TDF alongside a booster in sub-Saharan Africa.

Item Type:	Article
Schools and Departments:	Brighton and Sussex Medical School > Brighton and Sussex Medical School Brighton and Sussex Medical School > Global Health and Infection
Research Centres and Groups:	Brighton and Sussex Centre for Global Health Research
Subjects:	R Medicine > R Medicine (General)
Depositing User:	Deborah Miller
Date Deposited:	03 Jan 2020 14:54
Last Modified:	03 Jan 2020 15:00
URI:	http://sro.sussex.ac.uk/id/eprint/89012

View download statistics for this item

📧 Request an update