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Change in Renal Function among HIV-Infected Koreans Receiving Tenofovir Disoproxil Fumarate-Backbone Antiretroviral Therapy: A 3-Year Follow-Up Study.

Authors
 Kyoung Hwa Lee  ;  Ji Un Lee  ;  Nam Su Ku  ;  Su Jin Jeong  ;  Sang Hoon Han  ;  Jun Yong Choi  ;  Young Goo Song  ;  June Myung Kim 
Citation
 Yonsei Medical Journal, Vol.58(4) : 770-777, 2017 
Journal Title
 Yonsei Medical Journal 
ISSN
 0513-5796 
Issue Date
2017
MeSH
Adult ; Anti-HIV Agents/pharmacology ; Anti-HIV Agents/therapeutic use* ; Diet ; Female ; Follow-Up Studies ; HIV Infections/drug therapy* ; HIV Infections/physiopathology* ; HIV-1 ; Humans ; Kidney/drug effects ; Kidney/physiopathology* ; Kidney Function Tests* ; Kidney Tubules/drug effects ; Kidney Tubules/physiopathology ; Male ; Tenofovir/pharmacology ; Tenofovir/therapeutic use*
Keywords
HIV ; anti-retroviral therapy ; cystatin-C ; eGFR ; renal toxicity ; tenofovir
Abstract
PURPOSE: Tenofovir disoproxil fumarate (TDF) is commonly prescribed as a fixed-dose, co-formulated antiretroviral drug for HIV-1 infection. The major concern of long-term TDF use is renal dysfunction. However, little is known about the long-term patterns of changes in renal function in HIV-infected Koreans receiving TDF. MATERIALS AND METHODS: We prospectively followed 50 HIV-infected Koreans, performing laboratory tests every 3 months during the first year and every 6 months for the next 2 years. Urine N-acetyl-β-D-glucosaminidase (NAG) and plasma cystatin-C were measured using samples collected in the first year. Data on renal function were retrospectively collected on HIV-infected patients receiving first-line TDF (n=40) and in antiretroviral therapy (ART)-naïve patients (n=24) for 3 years. Renal function was evaluated as estimated glomerular filtration rate (eGFR) from serum creatinine [Modification of Diet in Renal Disease (MDRD)] and cystatin-C. RESULTS: The eGFR (cystatin-C) showed significant changes from 0 to 48 wks (p=0.002), with the lowest levels at 24 wks (84.3±18.8 mL/min vs. 90.3±22.5 mL/min, p=0.021 by post hoc test). Urine NAG levels did not differ at 0, 12, 24, and 48 wks, although eGFR (MDRD) significantly decreased from 0 (98.7±18.9 mL/min/1.73 m²) to 144 wks (89.0±14.7 mL/min/1.73 m²) (p=0.010). The first-line TDF group had significantly lower eGFR (MDRD) than the ART-naïve group at 144 wks (89.7 mL/min/1.73 m² vs. 98.4 mL/min/1.73 m², p=0.036). Thirteen (26%) participants experienced a decrease in renal impairment of 10 mL/min/1.73 m² in eGFR (MDRD) at 144 wks. CONCLUSION: These data suggest that clinically meaningful renal injury can develop in HIV-infected Koreans receiving long-term TDF.
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DOI
10.3349/ymj.2017.58.4.770
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
구남수(Ku, Nam Su) ORCID logo https://orcid.org/0000-0002-9717-4327
김준명(Kim, June Myung)
송영구(Song, Young Goo) ORCID logo https://orcid.org/0000-0002-0733-4156
이경화(Lee, Kyoung Hwa) ORCID logo https://orcid.org/0000-0003-0033-1398
정수진(Jeong, Su Jin) ORCID logo https://orcid.org/0000-0003-4025-4542
최준용(Choi, Jun Yong) ORCID logo https://orcid.org/0000-0002-2775-3315
한상훈(Han, Sang Hoon) ORCID logo https://orcid.org/0000-0002-4278-5198
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160214
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