Geoffroy Liegeon1, Linda Harrison2, Anouar Nechba3, Guttiga Halue4, Sukit Banchongkit5, Ampaipith Nilmanat6, Naruepon Yutthakasemsunt7, Panita Pathipvanich8, Suchart Thongpaen9, Rittha Lertkoonalak10, Thomas Althaus11, Marc Lallemant12, Jean-Yves Mary13, Gonzague Jourdain14. 1. Institut de Recherche pour le Développement (IRD) Unit 174-PHPT, Kaew Nawarat Rd, Tambon Wat Ket, Amphoe Mueang Chiang Mai, Chiang Mai, Thailand. Electronic address: geoffroy.liegeon@phpt.org. 2. Harvard T.H. Chan School of Public Health, Boston, MA, USA. 3. Institut de Recherche pour le Développement (IRD) Unit 174-PHPT, Kaew Nawarat Rd, Tambon Wat Ket, Amphoe Mueang Chiang Mai, Chiang Mai, Thailand. Electronic address: anouar.nechba@phpt.org. 4. Phayao Provincial Hospital, Phayao, Thailand. 5. Rayong Hospital, Rayong, Thailand. 6. Hat Yai Hospital, Songkla, Thailland. Electronic address: app-nil@windowslive.com. 7. Nong Khai Hospital, Nong Khai, Thailand. 8. Lampang Hospital, Lampang, Thailand. 9. Mahasarakam Hospital, Mahasarakam, Thailand. 10. Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand. 11. Institut de Recherche pour le Développement (IRD) Unit 174-PHPT, Kaew Nawarat Rd, Tambon Wat Ket, Amphoe Mueang Chiang Mai, Chiang Mai, Thailand. Electronic address: thomas.althaus@hotmail.fr. 12. Institut de Recherche pour le Développement (IRD) Unit 174-PHPT, Kaew Nawarat Rd, Tambon Wat Ket, Amphoe Mueang Chiang Mai, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, USA; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand. Electronic address: marc.lallemant@phpt.org. 13. INSERM SBIM, Hôpital Saint Louis, 1 avenue Claude Vellefaux, 75011 Paris, France. Electronic address: jean-yves.mary@inserm.fr. 14. Institut de Recherche pour le Développement (IRD) Unit 174-PHPT, Kaew Nawarat Rd, Tambon Wat Ket, Amphoe Mueang Chiang Mai, Chiang Mai, Thailand; Harvard T.H. Chan School of Public Health, Boston, MA, USA; Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand. Electronic address: gonzague.jourdain@phpt.org.
Abstract
OBJECTIVES: The risk of kidney dysfunction on the WHO recommended first line regimens containing tenofovir disoproxil fumarate (TDF) without protease inhibitors (PI) remains unclear in Asian patients, especially those with low body weight. METHODS: Using data collected in a multicenter clinical trial in Thailand and proportional hazard regression models, we compared the risk of a >25% estimated glomerular filtration rate (eGFR) reduction in HIV naïve patients initiating TDF or zidovudine (AZT) containing non-PI regimen. RESULTS: Of 640 patients included in the analysis, 461 (72%) received a TDF-containing regimen for a median 6.7 years and 179 (28%) an AZT-containing regimen for 6.5 years. The risk of a >25% eGFR reduction was not associated with treatment (HR 1.11, 95% CI 0.84-1.47, P = 0.46). In multivariate analysis, the risk of >25% eGFR reduction form baseline was associated with body weight at baseline (HR 2.12, 95% CI 1.48-3.02 for <48 kg patients and HR 1.64, 95% CI 1.20-2.25 for 48-59.9 kg patients, compared to those with >60 kg, P < 0.001) and hypertension (HR 4.03, 95% CI 2.0-8.0, P < 0.001). The effect of baseline weight on >25% eGFR reduction did not significantly vary with treatment (P = 0.27). CONCLUSIONS: The risk of eGFR reduction was not higher on TDF- versus AZT-based non-PI regimens. Although the risk of eGFR reduction was greater for patients of lower body weight, this risk was not significantly increased by TDF.
OBJECTIVES: The risk of kidney dysfunction on the WHO recommended first line regimens containing tenofovir disoproxil fumarate (TDF) without protease inhibitors (PI) remains unclear in Asian patients, especially those with low body weight. METHODS: Using data collected in a multicenter clinical trial in Thailand and proportional hazard regression models, we compared the risk of a >25% estimated glomerular filtration rate (eGFR) reduction in HIV naïve patients initiating TDF or zidovudine (AZT) containing non-PI regimen. RESULTS: Of 640 patients included in the analysis, 461 (72%) received a TDF-containing regimen for a median 6.7 years and 179 (28%) an AZT-containing regimen for 6.5 years. The risk of a >25% eGFR reduction was not associated with treatment (HR 1.11, 95% CI 0.84-1.47, P = 0.46). In multivariate analysis, the risk of >25% eGFR reduction form baseline was associated with body weight at baseline (HR 2.12, 95% CI 1.48-3.02 for <48 kg patients and HR 1.64, 95% CI 1.20-2.25 for 48-59.9 kg patients, compared to those with >60 kg, P < 0.001) and hypertension (HR 4.03, 95% CI 2.0-8.0, P < 0.001). The effect of baseline weight on >25% eGFR reduction did not significantly vary with treatment (P = 0.27). CONCLUSIONS: The risk of eGFR reduction was not higher on TDF- versus AZT-based non-PI regimens. Although the risk of eGFR reduction was greater for patients of lower body weight, this risk was not significantly increased by TDF.
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