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Tenofovir may not inhibit renal function
Cooper RD. Clin Infect Dis. 2010;51:496-505.
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Patients with HIV receiving tenofovir disoproxil fumarate were at an increased risk for loss of kidney function and renal failure than controls, according to meta-analysis results. However, the researchers do not recommend restriction of tenofovir use.
Although tenofovir disoproxil fumarate has demonstrated efficacy as part of combination antiretroviral therapy, recent research indicates trends toward significant nephrotoxicity associated with the drug. The aim of the current study was to determine the renal safety of ART regimens containing tenofovir in patients with HIV.
The research was conducted using Medline, Embase, Global Health, Scopus, Biosis Previews, Cochrane Library, Web of Science and existing systematic reviews. The 17 studies eligible for inclusion were prospective trials comparing tenofovir-containing ART regimens with non-tenofovir-containing regimens. There were nine randomized, controlled trials included in the analysis.
Study characteristics, participant characteristics, therapeutic interventions, renal function, bone density and fracture rates were among criteria evaluated.
The median sample size was 517 participants, according to the results. A variety of constituent ART regimens were observed.
Patients receiving tenofovir were significantly more likely to experience loss of kidney function than controls. A mean difference of 3.92 mL/min in calculated creatinine clearance between the two groups was observed (95% CI, 2.13-5.70). Tenofovir use also carried a greater risk for acute renal failure, (risk difference, 0.7%; 95% CI, 0.2–1.2).
Patients taking tenofovir were not at an increased risk for severe proteinuria, hypophosphatemia or fractures, according to study findings.
“Although [tenofovir disoproxil fumarate] use was associated with a statistically significant loss of renal function, the clinical magnitude of this effect was modest,” the researchers wrote. “Our findings do not support the need to restrict [tenofovir disoproxil fumarate] use in jurisdictions where regular monitoring of renal function and serum phosphate levels is impractical.”