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  • Open Access

Smoking, female gender and PI use are associated with decreasing renal function in TDF-containing HAART

  • A Uglietti1,
  • C Gervasoni2,
  • E Gabrielli2,
  • S Di Giambenedetto3,
  • R Cauda3,
  • R Esposito4,
  • P Grima5,
  • G Di Perri6,
  • R Maserati7 and
  • M Galli8
Journal of the International AIDS Society201013(Suppl 4):P84

https://doi.org/10.1186/1758-2652-13-S4-P84

Published: 8 November 2010

Keywords

Chronic Kidney DiseaseGlomerular Filtration RateTenofovirDisease EpidemiologyMedian Body Mass Index

Purpose of the study

Nephrotoxicity of tenofovir (TDF)-containing HAART may be associated to several factors related to treatment or to patient's characteristics. We tried to assess Glomerular Filtration Rate (GFR) changes and their relationship with multiple clinical parameters in an Italian cohort receiving a TDF-containing HAART.

Methods

OSMA-1 (Observational Study on Metabolic Abnormalities), a multicenter Italian study, was designed to evaluate since February 2008 the efficacy and the safety of TDF-based regimen in a real-life clinical setting. HIV infected, therapy naïve subjects were enrolled. GFR was estimated using Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. Statistical analyses used a parametric test and a mixed model was used to analysis changes from baseline to 6, 12, and 24 months, with the different variables as fixed effect plus visit (categorical) and baseline value (continuous as covariate).

Summary of results

We consecutively enrolled 172 patients (91.3% Caucasian; 72.2% males; mean age 39.3 yrs; 48.8% heterosexual; 36.6% smokers). At baseline median CD4+ cell count was 225 cells/µL (range 2 - 701), HIVRNA > 100000 copies/mL in 43.6%. Median Body Mass Index (BMI) was 22.6 for males and 21.9 for females. A boosted PI was given in 60.5% of cases. At 6-mos evaluation, Women had greater declines in GFR vs. Men, independently from the GFR equation used (means in W vs. M for CG, MDRD and CK-EPI, respectively: -7.2; -12.1; -10 vs. 0.5; -1.3; -0.3 mL/min/1.73 m2, p=0.0001 to 0.0026). No further decline was documented after 6 months. Factors associated with demography or treatment are shown in Table 1.

Table 1

Variable

CG

p-value

MDRD

p-value

CK-EPI

p-value

Increasing Age

decrease

0.0001

decrease

0.043

decrease

0.0006

Increasing BMI

increase

<0.0001

NA

ns

decrease

0.059

PI/r usage

NA

ns

decrease

0.072

decrease

0.023

Smoking

decrease

0.073

decrease

0.012

decrease

0.05

Female sex

decrease

0.0001

decrease

0.0009

decrease

0.0026

Conclusions

Our data suggest that long-term use of TDF is associated with a modest decline in GFR that occurs predominantly at the beginning (in the first 6 months) of therapy in HAART-naive women. However, the decline is small, does not seem to worsen over time, and may not have a relevant clinical effect. A decreasing GFR was also found in elder patients, in smokers and when a boosted PI is used.

Authors’ Affiliations

(1)
Foundation IRCCS Policlinico San Matteo Hospital, Infectious Diseases, Pavia, Italy
(2)
Department of Clinical Sciences, L. Sacco Hospital, Milano, Italy
(3)
Policlinico Gemelli, Infectious Diseases, Roma, Italy
(4)
Policlinico Universitario, Infectious Diseases, Modena, Italy
(5)
Santa Caterina Novella Hospital, Infectious Diseases, Galatina, Italy
(6)
Amedeo di Savoia Hospital, Infectious Diseases, Torino, Italy
(7)
Foundation IRCCS Policlinico San Matteo, Infectious Diseases, Pavia, Italy
(8)
Department of Clinical Sciences, L.Sacco Hospital, Milano, Italy

Copyright

© Uglietti et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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