Tenofovir-associated renal toxicity in a cohort of HIV infected patients in Ghana

Abstract

Objective: Tenofovir disoproxil fumarate (TDF) is a nucleotide analogue recommended in international HIV treat‑ ment guidelines. Purpose of this study was to estimate the long term efects of TDF on renal profle in a cohort of HIV patients in Ghana. Three hundred (300) consecutive HIV-positive patients who initiated TDF-based antiretroviral treat‑ ment in 2008 at the Korle-Bu Teaching Hospital were sampled. Creatinine clearance (CrCl) was calculated using the Cockcroft-Gault equation at baseline and renal impairment was defned as CrCl values of 30.0–49.9 mL/min (moder‑ ate renal impairment) and<30 mL/min (severe renal impairment) as per institutional guidelines for renal function test. Results: Median follow up time was 2.9 years (IQR 2.3–3.4 years). At study endpoint, 63 participants (21.0% [95% CI 6.5–26.1]) recorded CrCl rate below 50 mL/min indicating incident renal impairment, made up of 18.3% moderate renal impairment and 2.3% severe renal impairment. Factors associated with incidence of renal impairment were increasing age, decrease in creatinine clearance rate at baseline, WHO HIV stage III/IV and participants with BMI of<18.5 kg/m2 . Patients with identifed renal impairment risk factors at ART initiation should be targeted and moni‑ tored efectively to prevent renal injury.